Teen & Young Adult Group

I authorize my child to participate in Children’s Clinics Childhood Experiences Programs. I acknowledge the risks inherent in the participation by my child. In my absence, I further authorize the staff representing Children’s Clinics to act for me according to their best judgment in any emergency requiring medical attention for my child and I hereby waive and release those staffers, and volunteers of Children’s Clinics from all liability for any injuries or illnesses, that may be incurred while participating in Children’s Clinics Childhood Experiences, while in attendance, except for injury directly resulting from gross negligence or willful misconduct.

I consent to the photographing/video recording/ audio recording of the above-named patients by Children's Clinics staff at this event. I agree the resulting images or recordings may be used for Children's Clinics publicity or marketing purposes (brochure, pamphlet, lobby display, social media posts, printed material, etc.). I understand that I have the right to reverse this consent, in writing, at any time before the image or recording is used for the purposes indicated above.