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Parent or Guardian Authorization for a Minor Student to attend Foothill College OWL SUMMER CAMPS

The following authorization form must be completed by a parent or legal guardian of the applicant if the applicant is less than 18 years of age. A completed form must be on file in the with Foothill College Community Ed. summer program.
I,                                                                                 , hereby give permission for any and all medical attention to be administered
                     (print parent/guardian’s name)

to the minor student, _______________________________________________, in the event of accident, injury, sickness, etc. while
                                                                            (print student’s name)
attending Foothill College's Owl Summer Camps until such time as I may be contacted.  I also assume the responsibility for the payment of any such treatment.
As the parent/guardian of                                                                                 , I want the college to know about all current medical
                                                                              (print student’s name)
problems including psychological difficulties and serious allergies (animal, food, medicine, etc.) and physical limitations of the minor child as follows:




*Please note that the District will NOT administer medicine during the program.
Emergency Contact:      Name:                                                                          
                                      Telephone:                                                                  _

In case I cannot be reached, the following person is designated to act on my behalf:
                                      Name:                                                                            (other parent, guardian, or emergency contact)
                                      Telephone:                                                                  _
I understand and agree that the college does not assume responsibility for any injury or damage which might arise out of or in connection with such emergency medical treatment.
                                                                                                (parent or legal guardian’s signature)