Events

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Address *

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Address 2

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Parent Name *

First Name

Last Name

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Parental Consent and Release *

I give permission for my daughter to attend and participate in the virtual Dream It, Be It: Career Support for Girls, a program of Soroptimist International of Modesto North. I agree to the following, intending for me and my child to be legally bound: In case of medical emergency, I grant the facilitators the right to authorize medical care, if I cannot be promptly and readily reached. In the event medical treatment is necessary for my child, I agree to pay all costs associated with such treatment including the cost of emergency medical evaluation and care. I further agree to hold harmless and indemnify Soroptimist International of Modesto North for any costs associated with medical treatment and transportation for my child. I agree that Soroptimist International of Modesto North is not responsible for any bodily injury, illness or disease, or loss or damage from any cause concerning this program, even in the event of negligence by the club, its members or facilitators. I release and agree to hold harmless Soroptimist International of Modesto North members and facilitators from any liability in connection with the activities of this program. This consent and release shall be governed by the law of the state in which Soroptimist International of Modesto North is located, without regard to its principles on conflicts of laws. Photo/Video Release: I give my consent for my child to be photographed / videotaped during the Dream It Be It Activities and hereby authorize Soroptimist International and Modesto City Schools to use and reproduce these photographs/videos for publicity, promotional purposes and grant documentation.

Yes