Ensuring Safety for Our Youth

Interact Training Assembly

Medical and Liability Release Form
Interact Training Assembly
August 3, 2024

Must be completed by all students.

Please Print clearly and bring with you to Assembly

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Medical Transportation, Activity and Digital Media Release
Bullet Point Example
  • I give permission to District 5330 and its agents to select transportation to a medical provider who may provide proper treatment for, hospitalization of, order injections, X-ray examinations, anesthesia or surgery for my child as named above. The above named agent is authorized to make medical decisions concerning the health and welfare of my child.
Bullet Point Example
  • I voluntarily elect to allow the above named to participate in activities and assume the risk of injury or harm that could result from participation. On my own behalf and that of my personal representatives and heirs. I hereby release District 5330, its officers, club members and agents from all liability from any injury or harm to my child (or minor) from participating in any activity, in-person or online, with District 5330 whether the injury or harm is caused by accident or by negligence or otherwise. 
Bullet Point Example
  • I hereby agree that District 5330 may use any type of Audio and/or visual records, including Zoom meetings, for its promotional and/or commercial purposes withour compensation. 
Styled Text Example

I have read, understand, and agree to the above. My child may participate in any activity except as I have noted on this form.

Please list any activity that you do not wish to have our child participate in. If you have no restrictions please just enter N/A