General Permission Form

Please read and fill out the bottom portion of this form (including date and activity) and have a parent or guardian sign it for each individual "off-site" event that you attend.

Authorization for Medical Treatment and Release

If my child, or I as an adult participant, become(s) injured or ill during an activity at The Gathering at Windsor or any activity which includes traveling with a 'Gathering' group, to and from an activity, I hereby authorize The Gathering at Windsor and/or a representative of The Gathering at Windsor to secure, at my expense, medical treatment including surgery, for my child or myself if I should be unconscious. I hereby authorize all health care providers to release all medical information regarding my child or me, if I am an adult participant, to my personal or group insurance company and to The Gathering at Windsor.

Furthermore, I understand that there is always risk with any activity and I will accept personal financial responsibility for any injury sustained during the activity. Further, I promise to indemnify, defend, and hold harmless the activity sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the "Sponsor") for any injury related directly or indirectly to the described activity.

I give permission for my child/myself to participate in the event listed here:


Participant name:

Date:

Parent/Legal Guardian/Adult Participant:
(Print Name)

Parent/Legal Guardian/Adult Participant:
(Signature)

Please list emergency contact number:

Contact Patrick Lundberg at 970.217.5026 with questions or if you need to get a hold of your student while attending this event. Thank you.