Release and Consent

Child's Full Name:__________________________________________
Date of Birth:___________________
Parent(s) or Legal Guardian(s) Name: _________________________

Although the Montshire staff is trained to minimize accidents, events in the outdoors can create hazards for our program participants. Accordingly, we are required by our insurance carrier to have each participant sign a release.

I authorize the Montshire Museum staff to carry out standard first aid and CPR, including treatment for severe allergic reactions, and to arrange for emergency care for my minor child/ward at a local hospital, as the staff deems necessary. I authorize hospital personnel to provide emergency medical treatment for my child/ward.

I wish that my child/ward participate in summer camp program(s) which is/are organized and administered by the Montshire Museum of Science during the summer of 2008. I am familiar with and recognize the risks inherent in the program and I assume all the risks of injury and loss arising or resulting from my child's/ward's participation, hereby releasing and holding harmless the Museum, its employees or agents from liability for any such injury or loss.

I further authorize the staff of the Montshire Museum Summer Programs to take my child/ward on field trips requiring motor transportation (grades 3 and up only).

Unless otherwise informed, I allow my child/ward to appear in photographs solely taken for Museum publications.

Signed:___________________________________________________
(Parent or Guardian) (Date)

Signed:___________________________________________________
(Parent or Guardian) (Date)

Mail or drop off this Release and Consent to:

Summer Camps
Montshire Museum of Science
One Montshire Road, Norwich, VT 05055
or fax it to (802) 649-3637