Activity Permission & Medical Release Form

Event(Required)

Child Participant Name(Required)

Please complete one form per child

Participant Age(Required)

Participant DOB(Required)

My child has my permission to participate in the above program held at the Chisholm Trail Heritage Museum.

I release and waive all claims and damages arising from my child’s participation in this program to the greatest extent allowed by law. I understand that the Chisholm Trail Heritage Museum and its staff will not be held responsible or liable for any damages or injuries.

In the event of a medical emergency, I hereby give permission to the Chisholm Trail Heritage Museum staff to secure proper medical treatment for the registered participant named on this form. I also agree to pay for any fees and costs incurred in getting my child emergency medical treatment.

Emergency Information

Parent / Guardian Names(Required)

Relationship to Participant(Required)

Emergency Contact Name(Required)

Emergency Contact Phone(Required)

Email(Required)

Website & Media Permission

I hereby give permission to CTHM and its staff:

May we photograph your child?

Yes

May we publish your child’s photograph on our CTHM website or social media?

Yes

Signature of Parent/Guardian(Required)

Activity Permission & Medical Release Form

Emergency Information

Website & Media Permission

Hours

Admission

Tours

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