I/we, the parent(s) or legal guardian(s) of the above named minor, hereby give my/our permission for my/our child to participate in the CISEC-LC program and activities, including transportation involved for his/her participation in off-campus activities, and absolve CISEC-LC from liability to me/us and my/our children because of illness or injury to my/our child or loss of his/her property resulting from such participation. Further, I/we hereby assume all risk associated with my/our child’s participation the CISEC-LC program and activities, and agree to hold harmless CISEC-LC, its employees, agents, representatives, and volunteers from any and all liability, actions, course of actions, debts, claims or demands of any kind and nature whatsoever which may arise by or in connection my/our child’s participation in any activity related to CISEC-LC program.
In event of medical emergency, I/we hereby authorize CISEC-LC leadership to exercise its discretion in obtaining and/or providing medical attention for my/our child. I/we hereby assume full responsibility for all financial obligations arising from transporting my/our child to a medical facility, and for all other expenses related to obtaining and/or providing medical attention for my/our child. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is give to provide authority and release to obtain or render care which CISEC-LC leadership, in the exercise of its best judgment, may deem advisable. It is understood that effort will be made to contact the undersigned prior to rendering treatment to the patient, but that treatment will not be withheld if the undersigned cannot be reached.
Dear Parent or Guardian:
Your child has been referred to Communities In Schools of Lake County as someone who would benefit from CIS services. Your permission is needed for your child's general participation in Communities In Schools activities designed to increase school attendance, improve learning, encourage personal and social development and (in higher grades) increase employability and eligibility for college.
Among the services offered by CIS are counseling services, recreational activities, virtual/in-person academic and enrichment programs, linkages to health and human services, field trips, career exploration, and assistance in preparing for college. In order for your child to participate, your authorization and agreement the terms of this consent form, as evidenced by checking the boxes below, is required.