I/We, parent of the child named above, give full permission for my child to attend the UTFAV Tribal Youth Wellness Summit on July 16 - 18, 2018 being held at Camp Westminster on Higgins Lake, 116 Westminster Dr., Roscommon, MI 48653. By signing this permission slip, I accept general liability for the participation of my child in the activities listed above. I agree that Uniting Three Fires Against Violence, their staff, governing board, consultants and other participating agents, either jointly or separately, are free from and against any and all claims, injuries, damages, losses, costs, or other causes of action that may arise with this activity.
If my child were to have a medical emergency, I/We give UTFAV staff and their consultants, and the chaperones permission to seek medical attention for my child. By signing this I recognize that any cost to incur for administering medical attention is at the liability and responsibility of me acting as their parent and/or legal guardian. I will not hold Uniting Three Fires Against Violence responsible for any legal and/or financial costs or any other form of liability to seek emergency medical attention for my child.
In the event of an emergency, please contact me at the number listed below.
Please list any medical condition that your child has that may impact their ability to fully participate:
Example: Severe physical conditions, medicine, food allergies, etc