Consent for Release – Adult Participant

A multi-part consent form for adult participants in a youth workforce program, covering media release, information sharing, field trip travel, emergency medical treatment, and personal responsibility while on program premises.

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Program Participant Name:

Age:

Media Release (Enter Your Initials)

Consent to Disclosure and Release of Rights (Enter Your Initials)

Consent to Release of Information (Enter Your Initials)

Travel & Field Trip Consent (Enter Your Initials)

Consent for Emergency Medical Treatment (Enter Your Initials)

Acknowledgement of Responsibility (Enter Your Initials)

Section: Signatures

Participant Name

Participant Signature (18 & Up Only)

Sign here

Date

Emergency Contact Name:

Emergency Contact Phone Number

Insurance Carrier:

Policy/Plan#:

Regular Medications:

Special Health Conditions:

Consent for Release – Adult Participant

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