In the event that I am unable to be reached and my child requires medical, dental or surgical treatment while in the care of Girls Inc. of Sioux City, I hereby grant permission to the hospital, doctor, dentist or their designees to administer such medical, dental or surgical care/treatment as may be appropriate or deemed necessary. I agree to pay all costs and fees resulting from any such emergency medical, dental, or surgical care/treatment for my child as secured or authorized under this consent. This consent shall remain in effect from the date submitted until such time as my child is no longer enrolled with Girls Inc. of Sioux City.

I hereby give consent to Girls Inc. of Sioux City to photograph, videotape, or otherwise digitally record and use images and/or sound recordings of my child or children to use in any public media, including radio, television, internet, social media, print or in any of Girls Inc.’s or its partners’ publications, productions, or posts. I understand the intended use of such images and information is solely for the purpose of advertising, marketing, fundraising and/or the promotional and public awareness purposes for Girls Inc. and that identifying informing information will be limited to first names (if at all). I hereby waive any rights or interest in such images or recordings and forever discharge Girls Inc. (including without limitation all corporate affiliates and officers, directors, trustees, donors, employees, agents and volunteers) from any and all claims, liability, actions, suits, demands, costs, expenses or indebtedness arising out of, related to, or in any way connected with the use of images and materials described herein, and I hereby waive all rights and interest in and to such information and materials.

By submitting this form and with my signature below, I certify that all of the information in this enrollment form is true and complete to the best of my knowledge. I understand that my child must meet the age requirements and must be able to function appropriately in a group setting. I further understand that my child’s enrollment is not guaranteed and is not complete until I have submitted/completed all required forms. I further acknowledge that all fees paid are nonrefundable and that I will be responsible for all fees associated until such time as I officially unenroll her from the program.