Parent/Guardian Signature__________________________________________Date_____/_____/______

 

 

 

 

Parent/Guardian Signature__________________________________________Date_____/_____/______

 

Parent/Guardian Signature__________________________________________Date_____/_____/______

 

Parent/Guardian Signature__________________________________________Date_____/_____/______

 

 

 

 

 

 

  Text Box: Medical Release Form DiscoveryQuest Outdoor Learning Labs   General Information   Student Name_________________________________________   Age (at trip time) ________Sex_______   Parent or Guardian_____________________________________    Home Phone (____)________________   Address______________________________________________   Work Phone (____)________________   City ______________________________Zip________________   Second Parent or Guardian_______________________________   Work Phone (____)________________     Please note any special concerns, conditions, or restrictions the student’s teacher should be made aware of:     Authorization For Medical Care   I as parent or legal guardian of the above named minor hereby give permission for the release of medical records in the case of illness/injury.  The person herein described has permission to engage in all prescribed Outdoor Learning Lab activities except as noted above by me.  I give permission to DiscoveryQuest Outdoor Learning Labs staff to transport my child to or from a doctor and/or hospital for emergency treatment.  I also give permission to my child’s teacher or designate on duty to administer the medication as listed on this form and to perform treatment for minor injuries and illnesses.  Furthermore, I give permission to the DiscoveryQuest Outdoor Learning Labs Director or designate to allow hospital personnel and/or a licensed physician to perform emergency treatment and administer emergency medications.  This authorization shall remain in effect for the duration of the above mentioned minor’s stay at DiscoveryQuest Outdoor Learning Labs.   Release and Indemnity   I hereby certify that I give permission to my son or daughter to participate in the DiscoveryQuest Outdoor Learning Labs program.  I understand that even though the Learning Labs’ staff will make every effort to ensure the safety and well-being of my child, there are inherent risks of injury associated with outdoor activities.  I also give permission for my son or daughter to be transported in vehicles for approved transportation and activities.  Furthermore, I authorize DiscoveryQuest Outdoor Learning Labs to use photographs that may include my son or daughter in Outdoor School publicity.   In consideration of permission granted the herein named individuals to participate in camping activities, we hereby release and covenant with DiscoveryQuest Outdoor Learning Labs that we will never, individually or as legal guardians of said individuals, institute any action at law or in equity for any personal injuries, or injuries to property, real or personal, caused by, or arising out of related activities sponsored by DiscoveryQuest Outdoor Learning Labs, its successors and legal representatives; we further agree to indemnify and hold DiscoveryQuest Outdoor Learning Labs harmless against any and all costs, damages and expenses which may be incurred by them as a result of any law suit we might file against them.   Parent/Guardian Signature__________________________________________Date_____/_____/______   Parent/Guardian Signature__________________________________________Date_____/_____/______   Parent/Guardian Signature__________________________________________Date_____/_____/______   Parent/Guardian Signature__________________________________________Date_____/_____/______