I hereby give my consent for my son/daughter ("Child") to participate in Salesian College Preparatory Summer School. In rare instances, a medical or surgical emergency requiring treatment arises in which written consent by parents or guardians is legally required, but the proper person cannot be located. In this event, and in order to avoid delay that might jeopardize the life or health of my Child, I hereby provide the following permission, with the understanding that reasonable effort will be made to contact me in an emergency: I hereby grant permission to medical personnel rendering care to my Child to accept from the employees, coaches, officers, directors, agents, faculty, staff, and affiliates (“Staff”) of Salesian College Preparatory, permission, and consent for emergency medical and dental evaluation and treatment, including, but not limited to diagnostic, drug and/or alcohol testing, and/or surgical procedures on my Child. I further give Salesian College Preparatory Staff permission to release pertinent health information concerning my Child to the treating hospital and/or physician, and to give the treating hospital and/or physician permission to release copies of all medical records, laboratory and radiology reports to Salesian College Preparatory Staff. I agree that I will be responsible for any and all medical/pharmaceutical or other costs incurred that are not covered by my medical insurance.
I also agree that Salesian College Preparatory, including its Staff, will not be liable for any conditions that were known, unknown, or unforeseen arising from medical/nursing treatment or medications received by my Child.
I voluntarily agree, covenant, and promise to accept and assume all responsibilities, and risk for injury, death, illness or disease or damage to myself, my Child, or to my property arising from my Child’s participation in Summer School, and the use of the premises, facilities, equipment and services offered by Salesian College Preparatory in connection with Summer School.
I, for myself and for my Child, voluntarily release and forever discharge and covenant not to sue Salesian College Preparatory and its Staff and all other persons or entities affiliated therewith, from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my Child’s participation in Summer School, any and all activities related to Summer School, and the use of the premises, facilities, equipment and services offered by Salesian College Preparatory in connection with Summer School, including, but specifically not limited to any and all negligence or fault of Salesian College Preparatory and its Staff.
I further agree, promise and covenant, on behalf of myself and my Child, to hold harmless and to indemnify Salesian College Preparatory and its Staff, and all other persons or entities related to Salesian College Preparatory, from all defense costs, including attorney's fees, or from any other costs incurred in connection with claims for bodily injury, wrongful death, or property damage brought by me, my Child, or on our behalf.
I further acknowledge that I am in the best position to determine the physical ability of my Child to participate in Summer School, and acknowledge that my Child is in good physical and mental health, and is not suffering from any condition, disease or disablement which would or could potentially adversely affect participation in Summer School.
I understand that any photograph, sound recording, motion picture, or video taken of me or the minor Child attending the clinic is for the purpose of promoting the public good and the interests of Salesian College Preparatory. I hereby assign all rights, title, and interest, including copyright in and to any or all photographs, sound recordings, motion pictures, or videos to Salesian College Preparatory and authorize its agents and employees without limitation to reproduce, copy, sell, exhibit, publish, or distribute such in any medium now known or later developed, in perpetuity. I further release and forever discharge Salesian College Preparatory, its offices, agents, and employees from any and all claims and demands arising out of or in connection with the use of said photographs, etc., including but not limited to any and all claims for invasion of privacy, defamation, or infringement of copyright.
I have read and understood the provisions of this agreement and understand that I am free to obtain legal advice at my expense to interpret these provisions.
I HAVE READ THIS FORM, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT 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 FORM IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.