GMG Harp Forum Consent form 2018

GMG Harp Forum Consent form
Informed Consent Release Form GMG Studios, INC.
GMG STUDIOS/
P. O. Box 733/ Morrisville, Pa 19067
215-342-9397
www.gmgstudios.com

I, ( name of parent of Guardian or attendee) ………………… ,
of ……………………………(attendee) desire for ……………………………………to participate in GMG Harp Forum.
I understand that the GMG Harp Forum staff are NOT responsible for any accident or injury occurring to anyone during this program.
I ………………………………..expressly and explicitly release, discharge, and waive any and all responsibility of GMG harp forum, GMG Studios Inc. and Gloria Galante, arising from, in any manner, injuries to anyone as a result of their participation in this camp or pre-existing health issues.
My attendee has paid up to date accident and active/medical/ hospital/ bodily/ insurance.
Our insurance carrier is…………………..and policy number is ………………….. which will only be used in an emergency situation.If such an emergency should occur, please contact me immediately at the following number:………………………………..

Please check off any special circumstances, conditions, or allergies that the staff needs to be aware of:
asthma……. sinus……….. headaches……………cold………….flu…..
hay fever………..
diabetes………… epilepsy……..
High blood pressure………… other…………….
any food allergies…………………………….

By my signature I certify that I completely understand this document.
………………………………………………………………….
date………………….
GMG Studios Harp Forum