I do hereby authorize a member of the Cumberland County Sheriff's Department, as agent(s) for the undersigned to consent to X-Ray examination, anesthetic, medical or surgical diagnoses or treatment and hospital care to be under the general supervision and upon the advice of a physician or surgeon, or to consent to an X-Ray examination, anesthetic, dental, or surgical diagnosis or treatment and hospital care to be rendered to the undersigned minor by a dentist.

I understand that this is being signed in case of an emergency situation where medical treatment is needed and the authorized parent cannot be contacted with normal procedures. I understand that under most circumstances a parent or guardian will be contacted to handle all medical issues.

I, the parent or guardian of undersigned minor, hereby request that he/she be allowed to participate in the Sheriff's Youth Academy which may result in my child riding in a Cumberland County Sheriff's Department vehicle. I make this request with full knowledge that law enforcement is an inherently dangerous activity, and that I am exposing my child to the risk of serious bodily harm, including but not limited to the risk  of injuries resulting from the operation and use of said Sheriff's Department vehicle, and at the risk of injuries inherent in participating, even as an observer, in law enforcement activities.

In consideration for being allowed to participate in the Sheriff's Youth Academy, as requested, and with full knowledge and appreciation of the risks involved, I voluntarily agree to, and do hereby assume all risks of physical harm in connection with this request. I further agree not to bring any claim or suit with respect to any injuries my child may sustain against the State of Tennessee, the County of Cumberland, the Cumberland County Sheriff's Department, or any of their officers, deputies, employees, or any other entity involved in any way with the program and I agree to hold them harmless from and indemnify them for any and all claims, demands, suits and liability which might possibly arise out of my participation in this program as requested herein.

I certify that I have read this request and waiver of liability before signing it and I fully understand its contents.

I, hereby authorize the Cumberland County Sheriff's Office to publish photographs taken of me and/or the undersigned minor children, and our names, for the use of the Cumberland County Sheriff's Office and Cumberland Neighborhood Watch, Inc. printed publications, websites and other promotional areas.

 I release the Cumberland County Sheriff's Office and Cumberland County Neighborhood Watch, Inc. from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize the Cumberland County Sheriff's Office and Cumberland County Neighborhood Watch, Inc. confers no rights of ownership whatsoever. I release the Cumberland County Sheriff's Office and Cumberland County Neighborhood Watch, Inc., its contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children.