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One T-shirt is provided. You may purchase additional T-shirts toward the bottom of this form
General Parental/Guardian Consent: As Parent/Guardian I/WE hereby affirm that the student is in good health and suffers from no illness, disability or condition that requires the taking of medication on a regular basis unless that condition is disclosed and approved by program staff. Furthermore, I have no knowledge of any reason the student cannot participate in vigorous physical activity.
I/We expressively agree to be responsible for any medical bills incurred in the treatment of any illness or accident. In the event of any such accident or injury, I /We hereby consent to allowing any of the program supervisors to procure any medical treatment deemed advisable on behalf of our child or ward without prior consent.
I/WE understand that, as a condition of admittance as program participant, I/We, on behalf of all parents and guardians, and on behalf of the student, hereby release The Village Group and its affiliated programs, and all other employees or agents of The Village Group from any and all liability from injury or
illness, mental or physical, suffered by the program participant during or related to the program, unless caused by a willful act or gross negligence by the person or entity against whom the claim is made.
Medical Release: As Parent/Guardian I/We hereby give permission to The Village Group staff/volunteer to proceed with emergency treatment in the event of accidental injury or illness if the immediate family or listed emergency contacts cannot be reached.
PHOTO RELEASE: I further authorize The Village Group, its affiliates, its successors or assigns, the right to take photographs for marketing and other purposes, as it deems appropriate.
The purpose of the Federal Educational Rights and Privacy Act of 1974 is to protect the privacy of information concerning individual students by placing restrictions on the disclosure of information contained in a student’s education records. By signing below, I hereby authorize Georgetown County School District to release my education records (individuals age 18 and older) or the education records of my child as described below:
Individual(s)/Organization(s)/Agency(ies) to Whom Records May Be Disclosed: The Village Group
Purpose of Disclosure: To obtain, thru power school and local school officials, student
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