Parent / Guardian Permission Form

hereby give my permission for my child to participate in all activities with supervision by an individual associated with Mentoring Matters. I understand that this participation may include transportation of my child by an individual associated with Mentoring Matters. I understand Mentoring Matters will have conducted background checks on every individual associated with their agency that would be providing transportation or supervision for my child to be involved in these mentoring activities and that Mentoring Matters shall ensure that each individual providing transportation holds a valid driver’s license, insurance and an understanding of and compliance with car seat laws.

 

I, the parent/legal guardian do hereby release, acquit, discharge, indemnify, and hold harmless Mentoring Matters, their personnel, employees, agents, and volunteers from any and all cause or causes of action, including personal injury, illness, death, property damage, cost, charges, claims, demands, and liabilities of whatever kind, name, or nature in any manner arising from participation in the program activities by my child or in the transportation or supervision by an individual associated with Mentoring Matters.

 

Moreover, I the parent/legal guardian of said child, hereby agree not to initiate suit or any form of litigation or judicial proceeding or to make any claim or claims of any type against Mentoring Matters personnel, employees, agents, and volunteers from any and all cause or causes of action, including but not limited to personal injury, illness, death, property damage, directly or indirectly connected with or arising out of or by reason of the participation in program activities by my child or from transportation or supervision by an individual associated with Mentoring Matters.

 

This agreement is intended to cover all claims for all injuries, fatal or nonfatal, and illnesses of every name, type, kind, or nature, and property damage, if any, which are or may be sustained or suffered from any cause whatsoever directly or indirectly connected with or arising out of or by reason of the participation in program activities by my child or from the transportation/supervision by an individual associated with Mentoring Matters.

 

In the event of serious injury or illness, I will be notified. If I cannot be reached in an emergency, I hereby give my permission for an employee to seek medical care for my child. I also hereby give my permission to the physician to hospitalize, secure proper treatment for and to order injection, anesthesia, or surgery for the above-named child.