Parent/Guardian Consent Form: Steppin' - Boys to Men, Girls to Ladies Program

Child/Children Names, Age, and Shirt Size, *

(XS / S / M / L / XL / 2XL / 3XL)

Child/Children School *

1. Parent/Guardian: First and Last Name *

2. Parent/Guardian: First and Last Name (Optional)

Email Parent/Guardian *

Email Parent/Guardian (Optional)

1. Phone Number *

2. Phone Number (Optional)

Medical Information *

Please provide any relevant medical information about the minor that staff should be aware of. All information will be kept confidential.

Health Conditions/Allergies: *

Medications and Dosing Instructions (if applicable): *

Emergency Medical Treatment: *

In the event of an emergency, I authorize program staff to seek necessary medical treatment for my child.

Medications and Dosing Instructions (if applicable): *

Emergency Contact *

Name, Relationship to Participant, Phone Number:

Child/ Children Photos *

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50 MB limit per file

I'm interested in (Youth)

I Like to help

Volunteer (Parents) Mentoring (Parents) Sponsor (Businesses) Dance Instructor (16-20) Youth Apprenticeship (16-20)

Agreement for Participation: *

I understand that my child has a role to play as regards his or her safety and security. I will speak with my child about the need to honor safety rules and to behave responsibly.

I, the undersigned parent/legal guardian, for myself and on behalf of my minor child, hereby release, discharge, and hold harmless the Steppin' - Boys to Men, Girls to Ladies program, its organizers, instructors, volunteers, and the sponsoring MSU unit/department, from any claims, demands, actions, or causes of action, arising out of any injury, loss, or damage to my child or property, sustained in connection with participation in the program, unless caused by gross negligence or willful misconduct.

Please read and agree to the following: By signing below, I, the parent/guardian of the child(ren) listed above, hereby grant permission for my child(ren) to participate in the Steppin' From Boys To Men, Girl To Ladies activities and events. I understand and agree that SFB2MG2L and its staff, volunteers, and partners are not responsible for any accidents, injuries, or illnesses that may occur during participation in these activities and events. I also grant permission to SFB2MG2L to use photographs, videos, or other recordings of my child(ren) participating in these activities and events for promotional and archival purposes, including, but not limited to, social media, websites, and marketing materials.

By signing you agree to the terms

Authorization and Release (Media)

I grant permission for the Steppin' - Boys to Men, Girls to Ladies program to photograph, videotape, or otherwise record my child's participation in the program. I also grant permission for the program to use my child's name, likeness, voice, and performance in any promotional or educational materials, including but not limited to websites, social media, brochures, and presentations, without further compensation or notification.