My child(ren) has/have my permission to participate in the Bells Mill Bash May 29, 2025 at Bells Mill Elementary School, and I hereby certify the minor(s) is/are my student(s).

I, as parent or guardian of the minor(s), do hereby, for myself, my student heirs, executors and administrators, remise, release and forever discharge Bells Mill Parent Teacher Association and the Free State Parent Teacher Association, and all officers, employees and agents of each of the foregoing, acting officially otherwise, from any and all claims, demands, actions or causes of action on account of referred.

And I do hereby certify that to the best of my knowledge and belief said minor(s) is/are in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs.

I hereby advise that the above named minor(s) has/have had the following allergies, medicine reactions or unusual physical condition which should be made known to a treating physician. (Please list allergies or adverse reactions above.)