(Required for participation of minors)
If you do not need housing, briefly explain your housing plans.
The undersigned does herby give permission for their child, ________
to attend and participate in the Valley Rally on the dates of January 13-15, 2024.
We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical,
surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision
and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a
licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The
undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services
rendered to the aforementioned child pursuant to this authorization.
I hereby acknowledge that my child has voluntarily agreed to participate in the Valley Rally
which involves hiking and other outdoor adventure related activities such as repelling. I understand that the above activities and
all other hazards and exposures connected with these activities conducted in the outdoors do involve risk and I am aware of the
risks and dangers inherent with these activities. I understand and agree that any bodily injury, death, or loss of personal
property and expenses thereof as a result of my child’s negligence in any scheduled or unscheduled activities associated with this
event are my (the undersigned) responsibilities. I agree to defend and hold harmless the participants and leaders of the Valley
Rally for any injury or death caused by or resulting from my child’s participation in the activities, scheduled or unscheduled,
whether or not such injury or death was caused by their negligence or from any other cause.
By signing my initials below, I certify this is a release of liability.
By submitting this form, you are verifying your legal guardian signature.