Parent Consent Form

Parent's Name *

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Child's Name *

First

Middle

Last

Program(s) that your child is participating in.

ANMN Youth Summer Enrichment Camp (Jul 3, 2023-Aug 11, 2023)
ANMN Youth Code Camp – 2023 (July 8, July 15, Jul 22, Jul 30, Aug 5, Aug 12, Aug 19, Aug 26)
ANMN Nepali Language Class – Kakchya 2023 (July 8, 15, 22 & 30, and August 12, 19 & 26 )
ANMN Youth Dance Lessons Summer 2023 (July 16, Jul 23, Jul 30, & Aug 6)
ANMN Youth Leadership Program Summer 2023 (July 16, July 30, Aug 13, and Aug 20, 2023)
ANMN Youth Art Workshop Summer 2023(July 22, July 23, Aug 26, and Aug 27, 2023)

Medical Information *

Specify any relevant medical information or conditions that the organizers should be aware of, such as allergies, medications, or special needs. Also, mention if any medication needs to be administered during the program and provide instructions. Type NA or None if your child doesn't have any medical information that we need to know of.

Assumptions of risks, waiver of liabilities and consent

I hereby grant permission for my child to participate in ANMN’s Summer Enrichment Classes/Camps as described above. I understand that while reasonable precautions will be taken to ensure the safety and well-being of all participants, the organizers cannot be held responsible for any unforeseen circumstances or accidents that may occur during the program.

I acknowledge that Association of Nepalis in Minnesota (ANMN) and its representatives reserve the right to dismiss any participant whose behavior is disruptive, unsafe, or violates the program's rules and regulations. In such cases, I understand that no refund will be provided.

I also authorize Association of Nepalis in Minnesota to use photographs or videos of my child taken during the Summer Enrichment Classes for promotional purposes, including but not limited to websites, brochures, or social media platforms.

Consent/Authorization *

I hereby, by typing my name, date and time, grant my consent for my child to participate in Summer Enrichment Classes or camps organized by Association of Nepalis in Minnesota as above. I have read and understood the details provided in this consent form and agree to comply with the rules and regulations set forth by the organizers.

Full Name *

Date / Time *

Date

Time