Authorization and Release Agreement Sample Contracts
AGREEMENT, AUTHORIZATION, WAIVER AND RELEASEAuthorization and Release Agreement • January 21st, 2010
Standard Contracts
Authorization and Release AgreementAuthorization and Release Agreement • October 2nd, 2020
By my signature below, I indicate my agreement with the terms of this Authorization and Release with the American Heart Association, its affiliates, directors, officers, employees, agents, volunteers and representatives (collectively "AHA"). I,
AUTHORIZATION / RELEASE / AGREEMENT TO PAYAuthorization and Release Agreement • November 22nd, 2023
AUTHORIZATION AND RELEASE AGREEMENTAuthorization and Release Agreement • April 18th, 2023
Harpeth Hall (“Harpeth Hall” or the “School”) offers its Upper School students the opportunity to participate in the Winterim Program (“Winterim”), a three-week experiential program to occur from January 8, 2024, to January 26, 2024, and which provides students with an opportunity for cross-cultural experiences through academic travel as well as independent studies, and internships in Nashville and other places.
AGREEMENT, AUTHORIZATION, WAIVER, AND RELEASEAuthorization and Release Agreement • March 3rd, 2017
CAPITAN MUNICIPAL SCHOOLSAuthorization and Release Agreement • November 24th, 2009
AGREEMENT, AUTHORIZATION, WAIVER AND RELEASEAuthorization and Release Agreement • November 1st, 2023
AUTHORIZATION, ACKNOWLEDGMENT AND ASSUMPTION OF RISK, AND AGREEMENT TO RELEASE AND INDEMNIFY WESTERN MICHIGAN UNIVERSITYAuthorization and Release Agreement • March 12th, 2018
My child intends to participate in “Beyond the Lemonade Stand” an entrepreneurship camp for students who have completed grades 8 -12” sponsored by the Western Michigan University Haworth College of Business and the College of Engineering and Applied Sciences (the “Program”). I understand that the conditions for participation in the program must be agreed to, and this form must be fully completed and submitted to our office before my child will be allowed to participate in the Program.
Authorization and Release AgreementAuthorization and Release Agreement • October 27th, 2014
I, the undersigned parent or legal guardian of the named Player, enter into this Agreement knowingly and willingly. I hereby give my express permission and consent for the Player to participate in this event. I hereby release and hold Boca Raton Little League harmless from any injury, loss, damage to or by the Player. I agree to indemnify Boca Raton Little League for all injury, loss, or damage to the person or property of others caused by the Player. I release and hold Boca Raton Little League harmless from any liability for reasonable decisions or actions as may be taken to protect the health and safety of the Player. In the event of an accident or emergency, I authorize Boca Raton Little League or its representatives, to provide, or seek the provisions of healthcare services for the Player, at my expense, as deemed necessary. I release and hold Boca Raton Little League harmless from any and all liability resulting from such health care services. I further agree to assume full respon
AUTHORIZATION, ACKNOWLEDGMENT AND ASSUMPTION OF RISK, AND AGREEMENT TO RELEASE AND INDEMNIFY WESTERN MICHIGAN UNIVERSITYAuthorization and Release Agreement • April 26th, 2022
My child intends to participate in “Beyond the Lemonade Stand” an entrepreneurship camp for students who have completed grades 8 -12, sponsored by the Western Michigan University Haworth College of Business and the College of Engineering and Applied Sciences (the “Program”). I understand that the conditions for participation in the program must be agreed to, and this form must be fully completed and submitted to our office before my child will be allowed to participate in the Program.
ContractAuthorization and Release Agreement • January 29th, 2019
MIDAMERICAN ENERGY COMPANY AUTHORIZATION AND RELEASE AGREEMENT The undersigned Customer hereby designates CenterPoint Energy Services, Inc. (“Agent”) as Customer’s agent for the purposes of the Gas Transportation Contract or Agreement (“Contract”) entered into with the local distribution company, MidAmerican Energy Company (“LDC”). Customer authorizes LDC to accept from Agent nominations and to take other actions regarding Customer’s accounts, made by Agent on behalf of Customer for the purposes of the Contract. Customer further authorizes LDC for the purposes of the Contract to provide to Agent usage information, copies of billings, real-time information and such other information relating to the Contract as Agent may request and LDC deems necessary for performance of the Contract. This Authorization and Release shall not relieve Customer of any obligation under the Contract, including but not limited to, the obligation to pay any penalty assessed pursuant to the Contract or any appl
LOVING MUNICIPAL SCHOOLSAuthorization and Release Agreement • August 2nd, 2010
AUTHORIZATION AND RELEASE AGREEMENTAuthorization and Release Agreement • January 23rd, 2015
Camp Participant’s Full Name (please print) Age Gr. Level (upcoming Fall) Address Parent/Guardian (please print) Home Phone Number Cell Work
AUTHORIZATION, ACKNOWLEDGMENT AND ASSUMPTION OF RISK, AND AGREEMENT TO RELEASE AND INDEMNIFY WESTERN MICHIGAN UNIVERSITYAuthorization and Release Agreement • November 27th, 2017
Your child and [school] have asked Western Michigan University (WMU) to allow your child to participate in a learning experience in [name and location of lab] at WMU. You must agree to the below conditions for participation in the laboratory experience, and you must fully complete this form prior to your child participating in the [name the experience] laboratory experience at WMU.
AUTHORIZATION, ACKNOWLEDGMENT AND ASSUMPTION OF RISK, AND AGREEMENT TO RELEASE AND INDEMNIFY WESTERN MICHIGAN UNIVERSITYAuthorization and Release Agreement • October 16th, 2022
My child intends to participate in “Beyond the Lemonade Stand” an entrepreneurship camp for students who have completed grades 10 -12” sponsored by the Western Michigan University Haworth College of Business (the “Program”). I understand that the conditions for participation in the program must be agreed to, and this form must be fully completed and submitted to our office before my child will be allowed to participate in the Program.
A COPY OF THIS AGREEMENT, AUTHORIZATION, WAIVER AND RELEASE WILL BE SENT TO ALL REFERENCESAuthorization and Release Agreement • January 3rd, 2025
Authorization and Release Agreement FormAuthorization and Release Agreement • August 9th, 2020
OFFICE POLICIESAuthorization and Release Agreement • October 4th, 2018
All patients or guarantors (if the patient is a minor) are responsible for the full payment of services rendered by Acharya Periodontics and Dental Implants. By signing this agreement, I agree to pay at the regular rates and terms of Acharya Periodontics and Dental Implants and any remaining balance due after my insurance company processes my claim(s) and makes payment or in some cases denies my claims and does not make a payment. I accept full financial responsibility, regardless of insurance coverage, for the treatment provid- ed. I authorize and request that my insurance company remits payments directly to Acharya Periodontics and Dental Implants. I agree to present my insurance card at the time of my appointment along with any information required and necessary for any insurance claims to be filed. I authorize Acharya Periodontics and Dental Implants to release my diagnosis, records, treatment notes, x-rays, and any other information pertaining to my treatment or exams to a third-p
