2007 TJCL CONVENTION GENERAL PERMISSION/RELEASE FORM
(give a blank copy to each student for the appropriate information and signatures)
(turn in one copy of this form for each student attending the convention)
(all copies of these forms must be turned in at the start of the convention)
Student’s Name ______
School ______
Home phone number ______
Emergency phone number during convention weekend ______
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Signature of the parent or guardian gives the above-named student permission to attend and participate in the TJCL Convention on April 19-21, 2006 at Rhodes College. The parent or guardian assumes responsibility for any damages done by the above-named student to TJCL or school property. Signature of the parent or guardian also relieves the Tennessee Junior Classical League, Rhodes College, and their representatives of any and all liability connected with this convention. Signature implies that the parent or guardian acknowledges, understands, and agrees that in participating in this convention there is the possibility, however slight, of physical injury, and that the parent/guardian and the above-named student are assuming the risk of such injury by the student’s participation.
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(signature of parent or guardian) (date)
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MEDICAL INFORMATION AND RELEASE
In the event of an injury or illness to the above-named student during the convention, even if I cannot be contacted directly at the time, I hereby authorize the Tennessee Junior Classical League and its agents to provide and/or obtain any medical treatment they deem necessary. I hereby release the Tennessee Junior Classical League and its agents from any and all claims and liability arising in any way out of its exercise of this authority. I understand and agree that any and all costs for medical care and treatment that are not paid at that time will be forwarded to me or my insurance company and that it will be my responsibility to see that such bills are paid. I further acknowledge, understand, and agree that in participating in this convention there is the possibility, however slight, of physical injury, and that I and the above-named student are assuming the risk of such injury by the student’s participation.
______
(signature of parent or guardian) (date)
Insurance Information: Name of company ______
Location of company (city, state) ______
Insurance Policy Number ______
Name of policy holder ______
Family physician and phone # ______
Medical conditions/problems, and medications currently taken (mention dosage/frequency):