Please read the following statements and sign below to give your consent.
As the parent, legal guardian, or foster parent of the minor child listed above, I hereby certify that the above information is the most up-to-date and correct to the best of my knowledge that I agree to the following as a condition of my child’s participation in the GVSU program or visit and related activities.
I give my permission to GVSU, St. Mary’s Hospital, Spectrum Health Care System, or any other health care providers close to the field trip site to provide, seek, obtain, or approve any routine, necessary, or emergency health care during the minor child’s involvement in the GVSU programs. I understand that this authorization is given in advance of any specific diagnosis, or treatment or medical care being required and is to serve as specific consent to any and all such diagnosis, treatment or hospital care which may be deemed advisable. I understand my rights under the Health Insurance Portability and Accountability Acts (HIPPA) and authorize GVSU to release information as necessary for managing program health care.
I acknowledge that participation in the visit and related activities involves assumed and inherent risk of personal injury. I assume such risk on behalf of the minor child and give my permission to the minor child to participate in all program activities. I release and agree to hold harmless GVSU, its Board of Trustees, students, and employees from all claims, actions, damages and liabilities for personal injury or damage relating to or arising out of any activity except where the injury or damage is caused by the gross negligence of the University’s employees. I understand that the minor child will be subject to the rules and regulations of the GVSU visit and related activity. I understand that any person who repeatedly disobeys University policies or procedures, or those of the TRIO Talent Search program, will be immediately expelled from the program.