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expanding your horizons

Parents / Guardians - Please complete a waiver/permission slip for each child you are registering. If you have any questions about the permission slip, please contact Dr. Janet Clark.

Personal Details

Child's Name *

Parent/Guardian's Name *

Parent/Guardian's Email *

Parent/Guardian's

Phone *

EMERGENCY CONTACT

EMERGENCY CONTACT NAME *

EMERGENCY CONTACT PHONE *

Liability Release - READ BELOW

Liability Release:

Participants shall remain liable and hold Saint Mary-of-the-Woods College harmless for any liability arising from their participation in the Expanding Your Horizons Conference on Sept. 19, 2009, except injury or damages that may occur because of the sole negligence, or willful and wanton misconduct of the College, College’s officers, agents or employees.

Photo Permission:
I give my permission to use photos or videos that includes my daughter for the purpose of publicizing and promoting future Expanding Your Horizons conferences. I understand that the images and recordings may be published in local newspapers, the Internet, or used in other marketing material promoting the EYH conference at Saint Mary-of-the-Woods College. Names and other private information such as addresses, phone numbers, email or schools will NOT be published.

I have read the above liability release and permission statement and accept or decline.

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