Tiahitite Balance Watway SEO ankivee, hore Mwoncour Bs ae TeamName: Genesee Ke = Full Name: Nolokude 1 Cell Number; (4a aus - 24S> Badd Mather Woe addin’, Home Number: (B40) G54 3327 Please completely describe any medical condition which may recur or be a factor in medical treatment: IST avante andthe directors thereo rom any an liability, claims or demands fr persona injury, sickness or death, aswell as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned andor the child tarticioant that occur whe sad isoarticoating nthe above described tro or act. Furthermore (and or or on damage and expense as a result of participation in recreation and work activities involved therein, Further, authorization and permission is given to sald trip and travel organizers to turnsh and hereby release liability ot transportation, food and lodging for this participant. The undersigned further hereby agree to hold harmless and indemnify sid organization(s rectors, employees and agents, or any abit sustained by sid travel organizers isenaper ations oralivr ying 1 eyenis iv photsgraph,slaretape, codec lev, splat, dr los Tecan ey nope welce orden. |(end foror on behalf of my child paripant, funder the age of years) understand that MIST wil own these recordings (the participant has not attained the age of 8 years): | (we) are the parent(s) or legal guardian(s of this participant, and hereby grant our (my) permission former to sartcioate flv in sag event and hereby ve or oermisionOtake sid oaticioatto a doctor or hosital and hereby responsibilty of al medial bil ary. Further, should it become necessary forthe participant return home eto medical ceasons, cisciplinary action or otherwise, (we) ereby assume al transportation costs. ‘The information provided on this formis complete and accurate tothe best of my knowledge, Atleast one parent PorentiGversion Sig memes 3 338 8837 | info@mistdetroit.com | mistdetroit.com eT