Page 12 - Kids and Bees Resource Booklet_SP_Neat

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 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 med-

ical attention. I agree to assume all liability for any expenses incurred in such an emergency
(transportation, hospitalization, x-rays, etc.). I also understand and agree that the [Name of
Event/Program]will notify me if my child(ren) becomes ill during camp hours, and I will
arrange to have my child(ren) picked up immediately from [Name of Event/Program].

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 INDEMNITY AGREEMENT
(“AGREEMENT”).

In consideration of participating in the [Name of Event/Program], I, the minor’s parent and/or
legal guardian understand 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 damag-
es 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 (but 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/Program].

___________________________________________________________
Parent / guardian signature, date

___ 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 ap-
plicable, 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, demands, 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 of 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 result of
such claim.
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 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 full force and effect. 12