SANTA FE CAMPUS
PERMISSION, WAIVER OF LIABILITY & MEDICAL RELEASE FORM
Overnight visitors must complete this form. (You will not be allowed to stay overnight
unless this form is completed.)
Student: ____________________________________________ Date of Birth: ________________________
Email: ___________________________________________Student’s Cell:_________________________________
Please describe special dietary needs, medical problems, allergies to medications: ________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Parent/Guardian (or Emergency contact if 18 or older): _________________________________________
Email: _________________________________________________ Phone: ____________________________
I give permission for my minor child/ward to visit and stay overnight at St. John’s College in Santa Fe, New Mexico. In
consideration of my child’s/ward’s visit or my visit [I am 18 years old or older], I hereby agree to release, indemnify, and forever
discharge St. John’s College, its directors, officers, employees, and agents from any and all liability and responsibility for any
claim or cause of action, including claims based on negligence on account of any other person/entity, arising out of or in any
way associated with my child’s/ward’s/own visit to St. Johns’ College. I agree that my/my child/ward’s safety is primarily
dependent on my/my child/ward taking proper care of myself/himself/herself. Despite precautions, accidents and injuries may
occur and injuries may occur and/or loss or damage to personal property may occur as a result of participation in the visit. I
assume all risks related to participation in the visit. I agree that this waiver of liability and release is intended to be governed
by New Mexico law and to be as broad and inclusive as permitted under New Mexico law. If any portion of this waiver and
release is held invalid, the balance shall continue in full force and effect.
In case of an emergency and I cannot be reached, I, the undersigned parent/guardian of the above-named child/ward, do hereby
authorize a representative of St. John’s College to consent to any medical treatment or care deemed advisable. OR
In the case of an emergency and I am 18 years old or older and my emergency contact cannot be reached, I the undersigned
student do hereby authorize a representative of St. John’s to consent to any medical treatment or care deemed advisable.
I have read and fully understand all the provisions of this Permission, Waiver & Medical Release Form
___________________________________________________________________________________________
Signature of Parent/Guardian Printed Name Date
____________________________________________________________________________________________
Signature of Student (if 18 years old or older)
Printed Name Date
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