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  • PDF - Wyal Player Signup Form
    PARENT PERMISSION AND Release Form: The WOODBURY YOUTH ATHLETIC LEAGUE WYALTRAVELING BASEBALLTRAVELING SOFTBALLTRAVELING BASKETBALLPlayers must have an evaluation to participate on a WYAL teamCLINICS Non Member Clinic Participants must provide a Completed Release FormEVALUATION CLINIC FEE Cash Check PARTICIPANT INFORMATIONFirst Name Middle Name Last NameStreet Address Phone Email AddressCity Zip C...
  • PDF - Release Form Cssd 2014 15
    Microsoft Word - Release Form - CSSD (2014-15).docx Trust Use Only Sent Received Resent Household Number Authorization for Release of InformationChild Support Services Division ClearanceD C Opportunity Scholarship ProgramThis completed Form will be submitted to the Child Support Services Division of the Office of the Attorney General CSSD onbehalf of the below parent guarding releasing a report of...
  • PDF - Bwi Waiver
    BWI Waiver & Release Form WAIVER Release FORMWAIVER OF ALL CLAIMS Release FROM LIABILITYand ASSUMPTION OF RISKSWARNING BY SIGNING THIS YOU ALSO GIVE UP THE RIGHT TO SUEI Print Full Name hereby acknowledge and agreethat in attending Boreal Wilderness Institute courses treks vacations trips programs ororganized activities operated or sanctioned by the Boreal Wilderness Institute hereincalled the In...
  • PDF - Volunteer Disclosure Release Form For Bgc Massena Oct 2014v
    Volunteer Disclosure & Release Form Volunteer Disclosure Release FormBy signing the Volunteer Disclosure and Release Form the Volunteer applicant agrees1 To complete the Volunteer Information Form Volunteer Background Check Form with factual information2 To disclose any criminal offenses and or convictions relating or equivalent toMurder Child PornographyChild Abuse Kid Napping of a ChildRape Chil...
  • PDF - Alamy Stock Photography Release Forms
    Property Release Form Photographer nameAffix property photo hereAddressTelephone numberProperty Release numberOwner agent nameOwner s Permission and Rights GrantedI own or control the Property By signing this Release I hereby give the Photographer and Assigns my permission to use the Imagesdepicting the Property in any Media for any purpose which may include among others advertising promotion mark...
  • PDF - Ames Model Release Fillable 01
    The Ames Companies Inc Model Release Form In valuable and good consideration of my engagement as a model Participant and for no othercompensation which the parties agree is legally sufficient and upon the terms herewith stated Ihereby grant and give The Ames Companies Inc Photographer including its heirs legalrepresentatives assigns those for whom the Photographer is acting and those acting with i...
  • PDF - 1901a Adult Photo Release Form June2012
    1901a - Adult Photo Release Form-Dec2011.doc Photo Release Form for AdultsI hereby grant to Young Life the absolute and irrevocable right and unrestrictedpermission in respect of photographic portraits or any pictures Young Life had taken ofme or in which I may be included with others editorial or any other media such as filmor video to copyright the same to re-use publish and republish the same ...
  • PDF - Rules
    Microsoft Word - contest rules and Release Form.docx The Peculiarium rules and regulations forPortland s first annual outrageous vehicle drive- by contestSunday July 24th 2011The Freakybuttrue Peculiarium is holding Portland s first annual Outrageous Vehicle drive- bycontest with a grand prize of 250 00 for the most outrageous vehicle of 2011 The judging willtake place on Thurman St Between 1pm an...
  • PDF - 55c85123 9336 46a1 9287 E193d59a5af5
    Microsoft Word - CONSENT AND Release Form tattoo.doc CONSENT AND Release FORMSAMPLEI Name of Patron hereby give consent to Name of Operator ofName of Establishment to perform a tattoo body pierce and in consideration of doingso I hereby Release Name of Operator and Name of Establishment fromall manner of liabilities claims actions and demands in law or in equity which I or my heirs might now ...
  • PDF - Ms Washdcliabilityreleaseform
    LIABILITY Release Form LIABILITY Release FORMI a participant on the trip to Washington D Con April 11 thru April 13 2014 sponsored by the Port Jervis Middle School andapproved by the Board of Education do AGREE to all the following conditions1 Port Jervis Middle School Port Jervis City School District or group chaperonesacting on behalf of the Port Jervis Middle School shall not be held liable fo...
  • PDF - 2012 Detc Release Form
    Microsoft Word - Release Form 2012.doc DISTANCE EDUCATION AND TRAINING COUNCIL1601 18th Street N W Washington D C 20009-2529 202 234-5100 fax 202 332-1386 www detc orgRelease Formfor DETC s2012 Outstanding Graduateand Famous Alumni ProgramI hereby grant the Distance Education and Training Council the full and complete use of any informationabout myself for non-commercial use including any written ...
  • PDF - 2014 Fall Ampa Med Release Form
    Microsoft Word - AMPA Medical History and Release Form.doc Artistic Motion Preparatory AcademyMedical History and Release Form Fall 2014 Dancer Student Full Name Date of BirthParent Guardian Emergency Contact s during class timeName of Student s Doctor Phone1 Has your child ever been advised by a medical doctor not to participate in any athletic activityCircle one Yes NoIf yes explain 2 ALLERGIES ...
  • PDF - Minor Photo Release Form
    Microsoft Word - Minor Photo Release Form .doc Media Release Form for MinorsI give Southern Nazarene University permission topublish in print electronic or video format the likeness or image or audiorecordings of the minor listed below I Release all claims against the Universitywith respect to copyright ownership and publication including any claim forcompensation related to use of the materialsI...
  • PDF - Cgvn Medical Release
    Medical Release Form Parent Information For Team Members Under 18TO BE COMPLETED BY PARENT OR GUARDIANMUST BE COMPLETED BEFORE WEEKENDGIVE TO HEAD CHATeam Member s NameAddress City State ZipTelephone Number include area code Central Georgia Vida Nueva would like to inform you of some of the responsibilities that will be asked ofyour child during the preparation and execution of a VN weekend1 Pay ...
  • PDF - Release Form For Media Recording
    Microsoft Word - Release Form for Media Recording.docx Member Name DateMt Vernon GospelKnights Release Form for Media RecordingI the undersigned do hereby consent and agree that the GospelChoirs of Mt Vernon Inc its employees or agents havethe right to take photographs videotape or digital recordings of me while I am a member or parent of the GospelKnightsprogram and to use these in any and all me...
  • PDF - K 9 Karnival Registration Release
    K9 Karnival Registration and Release Form K9 Karnival Registration and Release FormOwner s Name Dog s Name Address Phone Number Contestant E-mail Liability Release StatementTraditionally the City of Inverness has a NO DOG ordinance for any of their public parks andwalkways However the City has afforded an exception to the ordinance for today s activities sothat pet owners throughout Citrus Count...
  • PDF - Island Surf Academy Release Form
    Island Surf Academy2012 Surf Release Form SPORT PARTICIPANT Release OF LIABILITY WAIVER EXPRESSASSUMPTION OF RISK AND INDEMNITY AGREEMENT FOR ISLAND SURFACADEMYPlease read and be certain you understand the implications signingI do herby affirm and acknowledge that i have been fullyinformed of the inherent hazards and risks associated with surfing and understand that injuries may occurin participat...
  • PDF - Confirmation Retreat Brochure 2012
    Registration Medical Release Form ConfirmationRetreater s NamePlease Check Boxes RetreatReady SetAdult Youth Male FemaleBirth Date If Youth Present GradeGoParent Guardian s NameAddressCity State ZipHome Phone Work PhoneSeptember 7thEmail and 8th 2012Congregation and CityInsurance CarrierGroup Policy Number Identification NumberMy child has permission to take part in all camp retreat activities and...
  • PDF - E472594c 2892 4a
    Minor Release Form and Consent to Treatment Register online at www oxnardrec org or at our recreation office at 545 South A StreetMinor Release Form and Consent to TreatmentPlease PrintCHILD S NAME AGE D O BFirst LastNAME OF PARENT GUARDIANADDRESSHOME PHONE BUSINESS PHONE CELL PHONE E-MAIL ACTIVITY Youth Football Camp July 11-15 2011 Including all related activities events and field tripsI the u...
  • PDF - Microsoft Word Camper Release Form Doc
    Microsoft Word - Camper Release Form doc.doc Dismissal InformationFOR CAMP USE ONLYSession Cabin A participant may be dismissed from Camp Zanika Lache due toAlert disruptive behavior illness or homesicknessChildren are entitled to a pleasant and harmonious environment at campThe program cannot serve children who display chronically or severeIMPORTANT disruptive behavior Chronically disruptive beha...
  • PDF - 2014 Student Release Form
    2014 Student Release Form 2014 Congressional Art CompetitionStudent Information Release FormPLEASE PRINT CLEARLY THIS INFORMATION IS USED FOR CERTIFICATES AND AWARDING SCHOLARSHIPSINCOMPLETE FORMS WILL NOT BE ACCEPTEDMEMBER DISTRICT INFORMATIONMEMBER OF CONGRESS NAME STATE WIPaul RyanSTUDENT INFORMATIONNAME GRADESTREET ADDRESSCITY STATE ZIPWIMAILING ADDRESS IF DIFFERENTSTUDENT EMAILT-SHIRT SIZEPAR...
  • PDF - Copyright Release Form 0
    COPYRIGHT Release Form INTERNATIONAL JOURNAL OF DEVELOPMENT RESEARCHThis Release Form appropriately completed and signed must accompany papers submitted to the IJDRJournalAuthor NameAddressAddressCity State Province ZipCountry EmailPhone FaxArticle TitleThe author s warrant s thata The submitted manuscript is his her their own original workb All authors participated in the work in a substantive wa...
  • PDF - Video Revolution 1 Patient Release
    Dental Patient Video Release Form Patient Video Testimonial Release FormYou must have your patients sign a testimonial Release Form before you maketheir video testimonial public by posting it onlineYour assistant can have the Release Form ready on a clipboard after you have dismissedthe patient but before they leave the operatoryAlternatively the front desk manager can request the sign-off as the ...
  • PDF - Liability Release Form1
    Microsoft Word - liability Release Form Liability Release Form Adel ArtworksI and my heirs in consideration of my participation with Adel Artworks on date ofphoto session at location s of photosession hereby releaseRachel Adel Postler and Adel Artworks from any and all liability for damage to or loss ofpersonal property sickness or injury from whatever source legal entanglementsimprisonment death...
  • PDF - Holiday Art Contest Release Form 2013
    Christmas Art Contest Release Form Christmas Art Contest Release FormBy submitting art work in our contest you are agreeing to the following terms andconditions Please read this carefully This Release Form must accompany the art workentry Thank you for your cooperationThe undersigned Guardian hereby gives permission for their Child to submitart work for consideration in the 2013 Children s Aid Soc...
  • PDF - Sjpamedicalreleaseform
    Medical Records Release Form St Joseph Physician AssociatesMedical Records Release FormBy signing this Form I authorize you to Release confidential health information about me by releasing a copyof my medical record or a summary or narrative of my protected health information to the person s orentity listed belowHIV AIDS I consent to the Release of any positive or negative test results for AIDS o...
  • PDF - Modelreleaseform2015
    Microsoft Word - Model Release Form CSLP2015 (2).doc Collaborative Summer Library Program953 6th Place SEMason City IA 50401-5261641-423-0005 voice641-424-5120 fax866-657-8556 toll freehttp www cslpreads orgModel Release Form for Publication and Video Purposes for the Teen Video ChallengeThis Release is a binding contract between the undersigned and Collaborative Summer Library Program CSLP It ins...
  • PDF - Medical Release Form 2014
    Servant Road 2014 Medical Release Form Servant Road 2014 Medical Release FormI hereby authorize the participation ofPrint name of parent or legal guardianmy child in all official activities duringPrint student s namethe mission trip scheduled for7 26 2014 through 8 3 2014 In theevent of illness injury or emergency I give my permission for the Servant RoadLeadership Team to make a decision regard...
  • PDF - Release Form
    Release Form Dear Parent GuardianPlease be advised that when hiring a caregiver to provide respite services for your child using theAlliance for Community Respite Care ACRC funds ACRC is not responsible for the actions qualityof care injuries or damages by that caregiver You as the parent guardian are considered theemployer of a caregiver you choose ACRC does require that any caregiver used to pro...
  • Sample Welcome Letter For Middle School Bible Story Jesus Calms The Sea

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