I, the parent or legal guardian of the student whose name has been entered in this form, certify that he/she has my full approval to participate in the Town of Princess Anne, Targeted Outreach Program. I give the program full permission to attain information on my child including, report cards and behavior reports. The individual identified on this form understands that all students are expected to abide by the program rules and be directly responsible for discipline at the program and if necessary, may, because of misconduct or disobedience, require a student to leave. In such instance, I will assume full responsibility for returning the student home. Further, I do release and hereby agree to hold blameless the Town of Princess Anne employees, and all its agents from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in any activities associated with the Targeted Outreach Program. I also release the lesser of properties (colleges) on which the program is held. I authorize the sponsor of this program, in the event that I cannot be reached by phone, to give consent to a physician and/or hospital for emergency medical or surgical treatment while in custody. I understand that I assume any financial responsibility for any expenses that may ne incurred for said emergency treatment. Further I do certify that the student whose name has been entered in this form is covered by adequate insurance. I have read and agree to the information above.