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Parent(s) Consent Form
Student's Name
(Required)
First
Last
Parent/Guardian's Name
(Required)
First
Last
Parent/Guardian's Email
(Required)
Parent/Guardian's Phone
(Required)
I understand that St. Olaf College and the SSS Summer Bridge Program have no obligation to provide health, accident, disability or hospitalization insurance for my child.
(Required)
Yes
No
I authorize any representative of the St. Olaf Student Support Services Program to secure emergency medical and/or dental treatment for my child if s/he is injured or becomes ill while participating in the Program. Any representative of the Student Support Services Program may sign authorization forms necessary to obtain treatment. I understand that the Student Support Services Program staff will make every effort to contact me should an emergency arise. I further understand that the Student Support Services Program and St. Olaf College will take no responsibility for costs arising out of such treatment.
(Required)
Yes
No
My child is allergic to the following medications and/or drugs:
(Required)
Please indicate your wishes concerning this matter by checking a box below:
(Required)
Please do NOT give my child any non-prescription drugs.
You have my permission to give my child non-prescription drugs that are not listed as causing an allergic reaction in my child.
I agree that my child will abide by the Motor Vehicle Policy as printed in the St. Olaf College Handbook. Students participating in the Student Support Services Summer Bridge Program will follow the same rules as first year St. Olaf students. I understand that transportation to and from all planned activities will be provided free of charge for all students participating in the SSS Summer Bridge Program.
(Required)
Yes
No
I hereby release and discharge the Student Support Services Program and St. Olaf College, its regents, officers, employees, agents, successors and assigns from any and all claims and liabilities arising out of my child's participation in the Student Support Services Program.
(Required)
Yes
No
I agree without limitation to indemnify, defend and hold harmless the Student Support Services Program, St. Olaf College, its regents, officers, employees, successors and assigns from any and all claims and liabilities asserted by or on behalf of my child arising out of my child's participation in the Student Support Services Program.
(Required)
Yes
No
This waiver will be governed by the laws of the State of Minnesota. I have read this waiver carefully and I understand and agree to be bound by the provisions of this waiver.
(Required)
Agree
Disagree
Date
(Required)
MM slash DD slash YYYY