The undersigned parent or guardian grants permission to the Board of Library Trustees of the Village of Morton Grove (hereinafter, the "Board") and the Morton Grove Public Library (hereinafter, the "Library") to take

_________________________________________________ (Name) (hereinafter, the "Minor") on the following field trip:

Event: ____________________________________

Location: ____________________________________

Date: ____________________________________

and with this signed agreement forever releases and covenants to protect, defend and hold harmless the Board, each member of the Board, and the Library, and their respective successors, officers, employees, servants, agents and assigns of and from any and all claims, damages, actions, suits, judgments, costs, attorneys' fees and liability of every kind and nature whatsoever directly or indirectly connected with, related to, resulting from, or arising out of the above-named Minor's participation in the activity described above, including, without limitation, any bodily injury or harm to the above-named Minor and any damage to property of said Minor, and the undersigned assumes personally and exclusively all responsibility and liability for any accident, injury, bodily harm and property damage which may occur to the above named Minor during the time of the activity set forth above, even if caused in whole or in part by the persons or entities herein held harmless.

The undersigned authorizes emergency treatment by a trained medical professional for the Minor _________________________ (Name) where parental or guardian's consent for such treatment is required and a parent or guardian is not readily available to give such consent.

Parent or guardian's name: ____________________________________

Signature: ____________________________________

Address: ____________________________________ Father/Mother/Guardian

Telephone Number: ____________________________________

Emergency Contact if parent unreachable: ________________________________ (Name/Phone)

Morton Grove Public Library Photo Release Form

I hereby give the Morton Grove Public Library staff or designee permission to take photographs of the above-named Minor alone or with others while participating in the above-named activity for the purpose of promoting the Morton Grove Public Library and/or its activities.

I hereby release and discharge the Board and the Library and any organizations involved in the above-described activity being photographed from any and all claims arising out of the use of such photos.

Date: ____________________________________

Address: __________________________________

Parent/guardian signature: ____________________________________

Approved by the Morton Grove Public Library Board of Trustees, September 14, 2006.

www.webrary.org/inside/polreleaseform.html
First published on the Web: 7/24/2006
Last updated: 10/16/2006