Permission Form
TRIO Talent Search

Permission Form

Student Basic Information
Student's name

First Name
Last Name
Gender
Grade level
School
Current Grade Point Average
Student Email
Student Cell
Area CodePhone Number

Student mailing address

Street Address
Street Address 2
City	Region
Postal Code	Country

Parent/Guardian Basic Information
Parent/Guardian Name

First Name
Last Name
Parent/Guardian Cell
Area CodePhone Number
Parent/Guardian Home Phone
Area CodePhone Number
Parent/Guardian Work Phone
Area CodePhone Number
Parent/Guardian Email
Emergency Contact (if parent/guardian cannot be reached)

First Name
Last Name
Emergency Contact Phone
Area CodePhone Number

Student Health Information
Allergies
Chronic Illness
Medications
Health Insurance Provider
Member/Group Number
Medical conditions that we should know about

Authorizations
Authorization for Medical and/or Surgical Treatment

I, the parent/guardian, authorize the responding emergency medical service and/or hospital admittance, and give my permission to administer treatment(s) as necessary for the well being of the Talent Search participant. (Medical Personnel will make every attempt to contact parent/guardian before any treatment is initiated).

Agreement to Participate and Release of Liability

I have read a description of the activity, and am aware that participation in the event/activity named below can be dangerous and may involve RISK of INJURY or DEATH. I understand that by participating in the activities identified above, I may be exposed to such risks and dangers, such as Acts of God, inclement weather, environmental conditions, equipment malfunction, acts of a third party, etc. I further understand that my participation in this activity, as well as travel to and from related events, may result in serious injury and may impair my future abilities to earn a living or to engage in other business, social and recreation activities. Given all these risks, however, I intend to have my son/daughter participate in this Fort Lewis College Talent Search activity. By my signature below, I hereby release and hold harmless the Fort Lewis College Board of Trustees, by and through Fort Lewis College, its officers, faculty, employees and agents (collectively Fort Lewis College), from any and all liability that may arise from my son/daughter’s participation in the above-referenced activities. I further agree not to sue or otherwise assert claims against Fort Lewis College arising from my son/daughter’s participation in the above-referenced activities. I understand that my son/daughter is subject to all policies and procedures established by Fort Lewis College Talent Search program. I understand that this document has legal implications and I have had the opportunity to have counsel to review this document before I have signed. Additionally, while participating in this activity, my son/daughter is subject to all Fort Lewis College policies and procedures, including the Student Conduct Code and will follow directions and guidelines from Fort Lewis College staff.

Your student will be expelled from the program and returned home at the expense of the parent/guardian if:
1. They will not treat all participants with respect.
2. They is in possession of alcohol.
3. They is involved in the act of theft.
4. They is involved in vandalism.
5. They is involved in sexual activity.
6. They will not follow all rules set by TS staff.
7. They will not use seat belts during transportation.
8. They takes or is in possession of drugs, unless doctor’s prescription.
9. They will not follow covid protocols as instructed include wearing a mask above their nose and mouth, social distancing, and any other specified regulations.
I have also reviewed the event information and I give my student permission to attend the event/activity named below.
Name of Event/Activity
Parent/Guardian Signature
Reset
Student Signature
Reset
Date
Month - Day - Year
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Permission Form TRIO Talent Search

Permission Form

Student Basic Information

Parent/Guardian Basic Information

Student Health Information

Authorizations

Authorization for Medical and/or Surgical Treatment

Agreement to Participate and Release of Liability

Your student will be expelled from the program and returned home at the expense of the parent/guardian if:

I have also reviewed the event information and I give my student permission to attend the event/activity named below.

Permission Form
TRIO Talent Search