COLLEGE & CAREER CONFERENCE

PERMISSION SLIP -

HOLD HARMLESS - MEDIA RELEASE

Permission Slip

Please fill out the following form.

Medical and Waiver Information

I also grant permission for my child to receive emergency medical treatment and to be hospitalized if necessary. It is understood that every attempt will be made to contact me or the persons listed above before taking this action. In an emergency requiring medical care and treatment, I hereby authorize any physician, hospital, or other healthcare provider to give such care to this student. I also hereby give permission to transport to/from a doctor and/or hospital by a chaperone or ambulance. I do hereby release, discharge, and hold harmless the ESU Scholars Staff, University and College agents, and volunteers, from any, and all liability and claim either we or your child may suffer as a result of these requests for medication and emergency treatment and participation in the activities of the College Prep Conference. I am aware that non-medical chaperones may administer or supervise self-administration of the requested medication(s) to my child.

Hold Harmless

Field Trip: College and Career Prep Conference and

                        Higher Education Facilities Tours

                       Date: June 16th, 17th 18th, 20th  2025

I consent to this field trip with the understanding that my child (the above-named student) can be relied on to follow instructions and that my child will not require continuous observation by any of the supervisors/chaperones.

I further understand that the ESU Scholars, Inc., University of Memphis, Christian Brothers University, Memphis Electrical, Tennessee College Applied Technology,  Rhodes College, Southwest Tennessee Community College and Boys and Girls Club staff and volunteers do not or may not carry insurance relative to this field trip for injuries to the students. I maintain that my child has insurance through my insurance carrier. I also agree to allow my child to ride in a vehicle with a board member as transportation to the events during the tour.

I fully recognize that this field trip involves an element of risk and I assume all risks and hazards incidental to my child’s participation. I do hereby release, absolve, indemnify and agree to hold harmless the ESU Scholars Inc., University of Memphis, Christian Brothers, and its agents, employees and officers and the field trip supervisors/chaperones from any loss, liability, damage or costs, including court costs and attorneys’ fees, resulting from my child’s participation in the College Tour and transportation provided during the tours.

I consent to the conditions stated above. I request that my child be allowed to participate in this College Tours planned and I specifically consent to his or her participation. If any emergency medical procedures or treatments are required during this field trip, I consent to the field trip supervisors/chaperones taking, arranging for or consenting to the procedure or treatment at their discretion.

MEDIA RELEASE PERMISSION

I hereby give the Empowering Students Universally (ESU) Scholars, Inc. the right and permission to publish/use photographs, video and/or audio tapes of my child, a student, registered in an ESU Scholars activity. 

I understand that such reproductions could be used to publicize/promote the ESU Scholars through the commercial print or television media and through its own media productions. 

I waive any right to inspect and/or approve the finished product and do release the ESU Scholars from any liability by virtue of distortion by processing.  I further agree that these items may be used for publication, broadcast or reproduction without limitation, or reservation, or any fee. 

In addition, I accept responsibility, knowing that this release is on file, to have it removed when and if I deem it disadvantageous or inadvisable to have my child featured in such a manner. (If you prefer your child not be involved in these types of activities, we will respect your wishes.)  

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