N2355 DuBorg Road Columbus, WI, 53925

Student Information

Parent/Guardian Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Photo/Video Release

I, the undersigned, hereby grant Wisconsin Academy permission to use the likeness of my child in a photograph in any and all of its publications, including but not limited to all of Wisconsin Academy’s printed and digital publications. I understand and agree that any photograph using my child’s likeness will become property of Wisconsin Academy and will not be returned.

I acknowledge that since my child’s participation with Wisconsin Academy is voluntary, my child and I will receive no financial compensation.

I hereby irrevocably authorize Wisconsin Academy to edit, alter, copy, exhibit, publish, or distribute this photo for purposes of publicizing Wisconsin Academy’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my child’s likeness appears.

Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.

I hereby hold harmless and release and forever discharge Wisconsin Academy from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Overnight Stay?

Consent to Treatment

I, being the parent/legal guardian of above listed, hereby give my consent for my child to receive medical treatment while staying overnight at Wisconsin Academy.

I understand that in the event of a medical emergency, the academy staff will make every effort to contact me. However, if I cannot be reached, I authorize the academy staff to seek and provide appropriate medical care, including but not limited to, hospitalization, surgery, and the administration of medication.

I acknowledge that I am responsible for any medical expenses incurred as a result of such treatment. I also agree to provide the academy with any relevant medical information about my child, including allergies, medications, and pre-existing conditions.

Please rest assured that your child’s well-being is our top priority, and we will take every measure to ensure they receive the best possible care.