Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Students Name: *FirstLastThe purpose of this form is to inform you of certain risks and responsibilities you will assume while your child is participating in Friends and Mentors Inc. to of PARENT/LEGAL RISKS AND DANGERSLike every other program that serves youth, a normal level of danger is associated with many activities and travel including, but not limited to, transportation delays or accidents, insect bites, victimization by criminal activity, and illness. Carefully consider these risks and dangers before deciding to allow your child to participate in Friends and Mentors Inc. ADMINISTRATIVE INSTRUCTIONS AND INFORMATIONYou have been provided information concerning the dates, times, duration, and location of scheduled events in which your child will participate. You are urged to carefully read all information and, if uncertain about anything, contact the Friends and Mentors Inc. Office prior to authorizing your child to participate. HEALTH INSURANCE, EMERGENCY INFORMATION AND AUTHORIZATIONParents or Legal Guardians are responsible for providing health insurance for their children. The following person should be contacted in cases of emergency: PARENT/LEGAL GUARDIAN RELEASE AND WAIVER If your child becomes ill or is injured while participating in any Friends and Mentors Inc. activity, your signature below indicates that you authorize its officials/staff members to obtain medical treatment to address the problem. Be advised that you are fully responsible for all expenses incurred for any medical care provided to your child while participating in Friends and Mentors Inc. Friends and Mentors Inc. assumes no responsibility or liability for any illness or injury to your child or his/her property caused by the acts or omissions of others during participation in Friends and Mentors Inc. By signing this form, you are acknowledging that you have been informed about certain risks and responsibilities associated with participation in Friends and Mentors Inc. and that you knowingly and voluntarily assume them. You also agree, for your child, yourself, your heirs and assigns, to release and hold harmless Friends and Mentors Inc., its employees and agents, from any legal claim or liability for any bodily injury and property damage that is caused to your child by the negligent act or omission of third parties while the youth is participating in Friends and Mentors Inc. Parent/Guardian Name *FirstLastRelationship to Child *Phone *Date / Time *DateTimeSignature * Clear Signature Submit