NL ENVIROTHON STUDENT RELEASE FORM – MEDICAL AND PHOTO All students attending NL Envirothon must complete this form and return it as part of the team registration process. Name of Participant _________________________________________ Parent/Guardian Name ______________________________________ Home Phone __________________ Alternate Contact Person
Work Phone __________________
___________________________ Phone _________
MCP Number ___________________________________ Doctor’s Name __________________________________ Medical Conditions/Health Concerns (medications, allergies etc.) ____________ ________________________________________________________________ ________________________________________________________________ Liability Release: I hereby release, hold harmless and indemnify the NL Envirothon Committee and the Model Forest of Newfoundland and Labrador at all their employees and volunteers from any legal liability, claims, damages and costs for any injury caused by or resulting from participation in the NL Envirothon. I hereby grant the right to photograph my dependant and use the photo and/or other digital reproduction of him/her for publication purposes in order to promote the NL Envirothon in media productions such as newsletters, websites etc. Signature of Participant ________________________ Date ____________ Parent/Guardian to Complete the Following: I, ______________________________________ (parent/guardian) give permission for my dependant, ___________________________________ to travel to the NL Envirothon in the care of ________________________________ (teacher/coach) for the purpose of participating in the NL Envirothon event. By signing below, I give consent for full participation, medical release, travel and photo consent (as described above)
Signature of Parent/Guardian _______________________________ Date __________________________