I, ______________________________, grant permission for my son/daughter,______________________________,
              (Parent's Name)                                                                                   (Attendee's Name)
 
to attend the Liberty Debate Institute and to be treated by a licensed physician (at the cost to the participant) in the

event of any injury, accident, or illness or other condition during the course of _______________________________ 
                                                                                                                            (Attendee's Name)

residence or time of participation at the Liberty Debate Institute. The Director and staff of the Liberty Debate Institute

and Liberty University will not be held liable for personal injury occurring in conjunction with the Liberty Debate

Institute. The Director and staff of the Liberty Debate Institute and Liberty University will not be held liable for any

injury occurring while using the transportation service provided as a courtesy by the Liberty Debate Institute or any

injury occurring while at the airport, bus station, or train station. The Liberty Debate Institute and Liberty University

will not be held responsible for the loss or theft of personal property. Institute participants will be held responsible for 

the damage or theft of any Liberty University property, including the dormitory and Liberty Debate Center.
 

__________________________________________ 
Signature of Institute Participant
 

_____________________ 
Date
 

__________________________________________ 
Signature of Parent or Legal Guardian
 

_____________________ 
Date
 

In case of emergency contact:

Name_________________________________________
 

Telephone Number___________________________
 

Medications being taken:____________________________________________

_________________________________________________________________

Allergies to Drugs:__________________________________________________

_________________________________________________________________

Special Medical Conditions:___________________________________________

_________________________________________________________________

Special Dietary Considerations (e.g., Vegetarian):________________________

_________________________________________________________________