Youth Cooperative Ambassador Program - Consent for Medical Treatment, Liability and Publicity Release Form

READ THIS FORM COMPLETELY AND CAREFULLY AS THIS DOCUMENT IMPACTS IMPORTANT LEGAL RIGHTS.

I/We the undersigned parent(s) or guardian(s) of

give my/our consent for him/her to participate in Youth Cooperative Ambassador Program, sponsored by DEMCO.

I/We authorize and direct DEMCO, its staff and volunteers, to direct and supervise my/our son/daughter. I/We further request and authorize, DEMCO through its staff and volunteers to secure any medical or other emergency services the said staff and volunteers in their reasonable discretion may deem necessary or desirable for my/our child during their participation in the Youth Cooperative Ambassador Program.

I/We hereby release and agree to hold harmless DEMCO, its officers, members, staff, and associated organizations together with their heirs, successors, or assigns from any and all causes of action, claims, damages, costs, expenses, compensation, personal injury, property loss, or any other loss or injury relation to participation by our child during their participation in the Youth Cooperative Ambassador Program.

I/We hereby grant permission to DEMCO to use photographs, likenesses, and/or videotaped images of our child for publicity purposes related to this activity.

Signed at , Louisiana,

 

 

Parent/Guarding Signature
Date
Parent/Guarding Signature
Date