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EPIC Permission Slip
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EPIC Program Waiver and Release Agreement
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I acknowledge that my child’s participation in EmpowerMT youth programs is voluntary and has inherent risks regardless of all feasible safety measures being taken. I have the opportunity to discuss any concerns with EmpowerMT staff and I can always contact EmpowerMT staff at any time at 406-541-6891.
I agree to accept responsibility for any loss, damage, or injury to my child that occurs during my child’s participation in this program that is not the result of fraud, willful injury to a person or property or the willful or negligent violation of the law.
I give permission for my child to ride in buses, cars, and other vehicles that are hired, rented, or driven by EmpowerMT staff and volunteers.
In the event it becomes necessary for the EmpowerMT employees and volunteers to obtain emergency care for my child, EmpowerMT nor its employees and volunteers will assume financial liability for expenses incurred because of an accident, injury, illness and/or unforeseen circumstances. I authorize EmpowerMT employees and volunteers to obtain all necessary emergency medical care and authorize any licensed physician and/or medical personnel to render necessary emergency treatment to my child.
EmpowerMT may photograph and record my child. I grant EmpowerMT permission to use and publish images and videos taken during EmpowerMT youth programs for publicity, promotional, and/or educational purposes (including but not limited to publications, newspapers, the internet, and other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
I recognize that some EmpowerMT leadership activities my child may have the opportunity to participate may take place during the regular school day. I understand that it is my child’s responsibility to follow their schools pre-arranged absence protocol and that my child is responsible for any missed school work/tests.
I have carefully read, clearly understand, and voluntarily sign this waiver and release agreement.