Page 12 - kids ebook

In the event that I cannot be contacted in the event of an emergency, I further hereby grant [your name, your school’s In the event that I cannot be contacted in the event of an emergency, I further hereby grant [your name, your school’s
name, or your organization’s name] permission to administer immediate treatment and/or take my child(ren) to a name, or your organization’s name] permission to administer immediate treatment and/or take my child(ren) to a
hospital emergency room via ambulance/emergency vehicle. I further authorize the attending medical personnel to hospital emergency room via ambulance/emergency vehicle. I further authorize the attending medical personnel to
execute on my child(ren)’s behalf any permission forms, consents or other appropriate documents relating to medical execute on my child(ren)’s behalf any permission forms, consents or other appropriate documents relating to medical
attention. I agree to assume all liability for any expenses incurred in such an emergency (transportation, hospitaliza- attention. I agree to assume all liability for any expenses incurred in such an emergency (transportation, hospitaliza-
tion, x-rays, etc.). I also understand and agree that the [Name of Event/Program]will notify me if my child(ren) be- tion, x-rays, etc.). I also understand and agree that the [Name of Event/Program]will notify me if my child(ren) be-
comes ill during camp hours, and I will arrange to have my child(ren) picked up immediately from [Name of Event/ comes ill during camp hours, and I will arrange to have my child(ren) picked up immediately from [Name of Event/
Program]. Program].

Further, I waive and release the [Name of Event/Program], its instructors, and employees, from any and all liability for Further, I waive and release the [Name of Event/Program], its instructors, and employees, from any and all liability for
personal injuries, illness, loss, or damage to property RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND personal injuries, illness, loss, or damage to property RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND
INDEMNITY AGREEMENT (“AGREEMENT”). INDEMNITY AGREEMENT (“AGREEMENT”).

In consideration of participating in the [Name of Event/Program], I, the minor’s parent and/or legal guardian under- In consideration of participating in the [Name of Event/Program], I, the minor’s parent and/or legal guardian under-
stand the nature of the above referenced activities and state that: stand the nature of the above referenced activities and state that:

____ I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my ____ I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my
participation in any activities at the [Name of Event/Program]. With full understanding of the risks associated with (bu participation in any activities at the [Name of Event/Program]. With full understanding of the risks associated with (but t
not limited to) hiking, outdoor play, bee stings, weather conditions, natural allergens, and other outdoor risks. not limited to) hiking, outdoor play, bee stings, weather conditions, natural allergens, and other outdoor risks.

I hereby give permission for my child, ________________________________, to participate in the [Name of Event/ I hereby give permission for my child, ________________________________, to participate in the [Name of Event/
Program]. Program].

___________________________________________________________ ___________________________________________________________
Parent / guardian signature, date Parent / guardian signature, date
___ I hereby release, discharge, and covenant not to sue grant [your name, your school’s name, or your organization’s ___ I hereby release, discharge, and covenant not to sue grant [your name, your school’s name, or your organization’s
name, program funders, and location of program] and if applicable, owners and lessors of premises on which the name, program funders, and location of program] and if applicable, owners and lessors of premises on which the
[Name of Event/Program] takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, de- [Name of Event/Program] takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, de-
mands, losses, or damages, on my account caused or alleged to because in whole or in part by the negligence of the mands, losses, or damages, on my account caused or alleged to because in whole or in part by the negligence of the
“Releasees,” or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver o “Releasees,” or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of f
liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify,
save, and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may incur as the re- save, and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may incur as the re-
sult of such claim. sult of such claim.

I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand
that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance
of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by
law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in
full force and effect. full force and effect.
___________________________________________ ________________________________ ___________________________________________ ________________________________
Name of parent/legal guardian (printed) Name of participant (printed) Name of parent/legal guardian (printed) Name of participant (printed)

_____________________________________________________________________ _____________________________________________________________________
Signature of parent / legal guardian, date Signature of parent / legal guardian, date

12 12