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IHA Ohio Hindi Summer Camp 2015
Parental and Volunteer Consent and Release Form
I, _______________________________________________________________, am the parent or guardian of
(Parent/Guardian)
_______________________________________________, a minor, who desires to participate in the IHA Ohio
(Student or Volunteer)
Hindi Summer Camp Field Trip from July 7 through July 25, 2015. I acknowledge that I have been fully
informed as to the nature of the activities at the Camp and the provisions for my child’s involvement, and I
hereby give my consent for my child’s participation in the camp activities. I acknowledge that my child will be
provided authentic Indian food, snacks and lunch, at the camp.
If your child has any food allergies, please check below:
My child has food allergy. I understand that the IHA Hindi Camp cannot take on the responsibility for my
child’s special dietary needs, and I will make my own arrangement for my child’s food while attending the
Camp.
In consideration of the permission granted to my child for attending the IHA Ohio Hindi Summer Camp, and
participation therein, I release and agree to hold harmless IHA Ohio Hindi Summer Camp, its agents,
employees, and officers from any and all actions or causes of action of any nature for personal injury or
property damage of any kind arising in any way from my child’s participation in the Camp activities including
the field trip and recital. I further acknowledge that this release is binding upon my heirs, successors or
assigns, that I have read the foregoing and understand its significance, and that I have executed this
document voluntarily.
IHA Ohio Summer Camp 2015 utilizes Facebook, Twitter, Instagram, Linkedin, YouTube, Google+ and other social media platforms
for the free exchange/share of information, communication, pictures and videos. At times we will take pictures of students,
teachers, volunteers, adminstration staff etc. with facilities or people during the complete program onsite or offsite and post them
to the various social media outlets that we use, as well as to our website.
Your child may be photographed, video or audio taped while attending the IHA Ohio Hindi Summer Camp, from July 7 through July
25, 2015 for posting on our website at www.hindi-indianculturecamp.com, and facebook. Please, put a check mark next to one of
the statements below:
I give my consent to have my child photographed and video recorded while attending the camp.
I do not give my consent to have my child photographed and video recorded while attending the camp.
I have signed this form on ___________________________________________
(Date)
____________________________________________
(Parent/Guardian /Volunteer)
____________________________________________
(Address)
____________________________________________
(Telephone Number)
Instructions:
1. Please read entire form, if there is anything about this form or the described activity that you do not
understand, do not sign the form until you are satisfied that you have obtained a complete and
satisfactory explanation.
2. Fill in all the blanks.
3. If you have more than one child participating, please complete one form for each child.