PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT

MEDICAL INFORMATION

Medical Consent, Liability Waiver, and Emergency Authorization

MEDICAL TREATMENT CONSENT

In the event of a medical emergency and I cannot be reached, I authorize Courtney Nickol & Associates staff or program representatives to seek emergency medical treatment for my child. I understand that every reasonable effort will be made to contact me immediately in the event of an emergency. I accept responsibility for any medical expenses incurred

LIABILITY WAIVER AND HOLD HARMLESS AGREEMENT

I understand that participation in the Courtney Nickol & Associates Youth Leadership Development Institute involves group activities and learning experiences. I agree to release and hold harmless Courtney Nickol & Associates, its staff, volunteers, and program partners from liability for injuries or damages that may occur during normal program participation.

PHOTO / MEDIA RELEASE

Courtney Nickol & Associates may take photographs or video recordings during Youth Leadership Development Institute activities for educational, promotional, and program documentation purposes.