Future Leaders Forum for Young Women 2017

Saturday, March 18, 2017 8:30 a.m. - 3:30 p.m.
Capital One
15000 Capital One Drive
Henrico VA 23238

Student Information

Personal Statement

Parent/Guardian Information

Relationship to Student: *

Permission & Emergency Medical Release Form

EMERGENCY MEDICAL RELEASE In the event of an emergency, I give my permission for Capital One to provide first aid and to transport my child to a medical facility, if necessary. In case of an emergency, if I, or the contact named below, cannot be reached personally, I consent to treatment of my child under the supervision of and as deemed advisable by a licensed physician. I indemnify, release and hold harmless Capital One Financial Corporation; and their affiliated corporations, subsidiaries, affiliates and other related entities; their joint venturers, stockholders, successors, assigns, insureds, officers, directors, agents, representatives, employees, contractors and other personnel, jointly and severally, and any first aid/medical care providers they may engage from any claims related to my child’s participation in the Future Leaders Forum for Young Women; the provision of first aid to, and emergency medical care and treatment of, my child; and including any accident, injury or death arising in connection therewith. *
Please sign below to give your student permission to attend Capital One's Future Leaders Forum for Young Women. *
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