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SHINDIG RELEASE FORM
I understand that participation in Monster Scouts activities involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered.

Information about those activities may be obtained from the activity coordinators. I also understand that participation in these activities is entirely voluntary and requires participants to follow instructions and abide by all applicable rules and the standards of conduct.

Parents/guardians are responsible for their children at all times.

In case of an emergency involving my child, I understand that efforts will be made to contact me. In the event I cannot be reached, permission is hereby given to the medical provider to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose protected health information to the adult in charge and/ or any physician or health care provider involved in providing medical care to the participant. Protected Health Information/Confidential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.

With appreciation of the dangers and risks associated with programs and activities including preparations for and transportation to and from the activity, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against Steam Crow LLC, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with any program or activity.

NOTE: Steam Crow LLC and local councils cannot continually monitor compliance of program participants or any limitations imposed upon them by parents or medical providers.

Email address
Your Name
Your Address
Child/Children's Names
Your Phone Number
List any restrictions imposed on a child participant in connection with programs or activities below and counsel your child to comply with those restrictions.
Please be aware that you consent to your voice, name, and/or likeness being used, without compensation, in films and tapes for exploitation in any and all media, whether known or hereafter devised, for eternity, and you release Steam Crow LLC., it’s successors, assigns and licensees from any liability whatsoever of any nature. Sounds evil, but we just want to make promotional videos and photos at the event.
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