If an emergency or a crisis arises, university or program staff may get in touch with a parent or guardian and/or other listed contact. Please list information for these two sources below:

IN CASE OF EMERGENCY (Contact in the event that parent/guardian cannot be reached)

I, (parent/guardian's name) (your name) {name-2-first-name} {name-2-last-name}, am the Parent/Legal Guardian of (partipant's name) {name-1-first-name} {name-1-last-name} and I ask that he/she be permitted to participate in the above named program. I understand and acknowledge that scheduled activities of the program include inherent risks listed above. I understand that activities of the Program may include interactions with adult staff from Illinois State University, college students, and other youths from the community. I also understand that my child/guard must adhere to all rules and regulations of Illinois State University during participation in the program. To the best of my knowledge my child/guard does not have any medical condition or physical limitation that would put him/her at risk for injury as a result of his/her participation in the program.
In consideration of my child/guard's participation in the program, I understand and acknowledge that we are assuming all risks of injury or damage to personal property which may result from participation in the
program and his/her use of Illinois State University facilities and I hereby waive, release and hold harmless Illinois State University, and its affiliates and subsidiaries as well as its trustees, officers, directors, representations, employees and agencies, successors and assigns of and from any and all actions, causes of action, suits, claims, damages, and expenses whatsoever for any injury, loss, damage, accident,
inconvenience or expense, relating to or arising from his/her voluntary participation in the program, unless otherwise provided for by law.

EMERGENCY TREATMENT
In case of accident, illness or other emergency, I request that the Program/Activity Event Organizer contact me. If neither I or another emergency contact cannot be reached after conscientious effort, I
give permission for the Program/Activity Event organizer or staff member to call paramedics or any licensed physician or dentist. In case of a life-threatening emergency, I give permission for Program/Activity Event Organizer or staff member to call paramedics immediately and then contact me as soon as possible thereafter.

MEDICATION
I understand that program staff will not store, administer or track medication during the program. Participants who require prescribed medication in order to participate in this event or are self-administering prescribed medication, and require storage of the medication, must complete additional forms.