Hung Vuong Gifted School

Model United Nations

CONSENT FORM

Phone numbers: Name - Phone number

Example: Nguyen Van A - 0123456789

Parent/Caretaker: ………………………………………………………………...
Parent/Caretaker: ………………………………………………………………...
Emergency Contact: ……………………………………………………………..

A. Transportation
I desire to have my child transported to and from Phu Tho province. Thus, consent
to have my child transported back to our hometown once the activity is done.

I have been advised by staff that the vehicle used is not an ambulance, and is not
equipped to provide supportive care for my child. The driver will not provide
supportive care for my child during travel time.

I understand the major risks and potential complications associated with

transporting my child, including the risk of death. I understand that great care will
be taken during my child’s transport.

I hereby accept that the transportation of my child to and/or from Phu Tho
province will be at my own risk. I agree to hold the facility and its staff from
any and all injuries or medical deterioration that might occur during this
transportation.

B. Medical Treatment
I give permission to the staff:
 to administer any relevant treatment or medication to my child when/if
necessary.
 to take my child to hospital and give full permission for any treatment
required to be carried out in accordance with the hospital diagnosis.

I understand that I shall be notified of the hospital visit and any treatment given by
the hospital prior to any actions being taken.

C. Use of Personal Image

I grant permission to CHVMUN and to those acting with its permission to take
photographs and/or make video recordings of my child at CHVMUN2020 held on
July 4 and 5, 2020. This material may be retained and used by CHVMUN in print,
electronic publicity and its website.

I understand that I have no ownership interest in the photograph(s) or materials in

which my child is included and that I will not receive payment of any kind of their
use.

Signature of Participant Date

Signature of Parent/Caretaker Date