MHC Parent Signature Document

Parent Agreement:

I understand that the information I have provided here is for the use of MHC After 3 and partner agencies only and will remain confidential. I relieve the program of any responsibility for any accidents, illnesses, or injuries which may result from participation and allow them to take pictures for program documentation and promotion. I give my permission for MHC After 3 to review my child's school records for the purposes of recording grades, reviewing test performance and reviewing school attendance rates.

Be it known that I, as parent/guardian of the named student, hereby grant unto any medical doctor or hospital my consent and authorization to provide such aid, treatment, or care to said student as, in judgment of the doctor or hospital, may be required on an emergency basis in the event said student should be injured or stricken ill while participating in an IMIN/MHC After 3 sponsored event or field trip.

I understand my child can sign out of the program at any time and the liability of the MHC After 3 program ends at the time they sign out of the program for the day.

Yes, my child has permission to participate in fieldtrips, activities and events sponsored by MHC After 3

Sign with your finger or computer mouse on the line below

You MUST click Keep this signature