2009 OKLAHOMA ENVIROTHON

Attendees Release Form

This form must be filled out and signed by all attendees (teachers, students, parents, agency employees) of the 2009 Oklahoma Envirothon.  If attendee is a minor, the form must be signed by the parent or legal guardian.

Attendees Name __________________________________________________________

Home Address ____________________________________________________________

                         ___________________________________________________________

Home Phone _________________________  Work phone __________________________

                                                                                           (if team member, provide parent’s work number)

County _____________________  School/Group _________________________________

Emergency Contact ___________________________  Phone ________________________

Relationship to Attendee ____________________________________________________

Insurance Provider _____________________________  Policy # ____________________

Medication currently being taken  -  please name and give administering instructions _______________________________________________________________________

Date of last Tetanus Booster ____________________________________ (month and year)

* I understand this is an outdoor event that may be strenuous and adverse weather conditions may occur.  I acknowledge that there is the possibility of accident or injury while attending the Oklahoma Envirothon competition.  Nevertheless, I assume the risk involved.  I hereby release the Oklahoma Envirothon and all others participating in the Oklahoma Envirothon competition.  This release is total and without reservation on my part.  By signing this form, I acknowledge that I have read this form and understand it.

* I hereby give my consent to the use of any photographs, audio and/or video taken of me by officials of the Oklahoma Envirothon, or their representatives, for editorial and/or promotional use only.

__________________________________________________  Date ________________

(*Signature of attendee gives consent for full participation, medical release, travel and photo consent.)

I, _________________________ give permission for my child, ______________________

(parent/guardian)                                                                                                                                 (minor’s name)

to travel to the Oklahoma Envirothon in the care of ________________________________

(teacher/advisor’s name)

for the purpose of attending the 2009 Oklahoma Envirothon Competition.

______________________________________________  Date ___________

(*Signature of Parent/Guardian gives consent for full participation, medical release, travel and photo consent.)