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CONSENT & PERMISSION FORM
Please print and complete this form and mail to
the Jamboree Co-Chairman (see below).
Student’s Name:
Date of Birth: ___/___/_____
New England
Youth A Capella
Jamboree
Souhegan High School, Amherst, NH
Date: October 21, 2006
Parental Permission: (For
participants under 18 years of age)
I, the undersigned, accept full
responsibility for my child’s participation in the New
England Youth A Cappella Jamboree, to be held on Ocotber 21,
2006. I agree not to hold the Jamboree staff, members
of the Nashua Chapter nor the Barbershop Harmony Society,
nor Harmony Incorporated nor Sweet Adeline’s International
nor any chapter or individual(s) associated with these
entities, responsible for the welfare of my child while
traveling to and from and participating in, this event or
rehearsals. I hereby consent to the Youth participating in
the Jamboree and any rehearsals. I hereby allow the Jamboree
staff to chaperone, supervise, and conduct the activities
of the Youth as a participant in the Jamboree. I hereby
grant the Jamboree staff my permission, full authority and
responsibility, in my place and stead as a parent, to
supervise the Youth as fully and completely as I might do if
I were personally present, as deemed necessary and
appropriate. In the event of any medical emergency involving
the Youth, I further hereby authorize such supervisor(s) to
obtain, provide, give consent, or furnish authorization for,
any necessary emergency medical services or treatment to the
Youth, including (but not limited to) surgical procedures
which may be recommended by a physician, it being my desire
that the Youth be provided with such emergency medical
services or treatment as soon as reasonably possible, after
a need arises. I understand and agree that if any Chapter,
District, Barbershop Harmony Society, Sweet Adeline’s
International, or Harmony Incorporated member provides such
supervision, such member will be performing that function in
his individual and personal capacity, and not as an agent or
representative of the Chapter, District, Barbershop Harmony
Society, Sweet Adeline’s International, or Harmony
Incorporated.
Parent/Guardian Name (Print):
__________________________________________________________
Parent/Guardian Signature
____________________________________
Date:______________
Mail to:
NE Youth A Cappella Jamboree
Charlie Oliver, Co-Chair
18 Tuck Road
Hampton, NH 03842-1225
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