I give my child permission to attend feild trips with the Boys & Girls Club of Flagstaff, during the 2017 Summer Day Camp program.
In consideration for being allowed to participate in any way in the program, related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:
1. The risk of injury from the activities involved in this program exists, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist and,
2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove my self from participation and bring such to the attention of the nearest official immediately and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Boys & Girls Club of the Flagstaff, their officers, official s, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event, with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the releases or otherwise, to the fullest extent permitted by law.
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above. All the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, even if arising from the negligence of the releases, to the fullest extent permitted by law.
I hereby give my permission to the medical personnel selected by the Boys & Girls Clubs to order x-ray, routine tests and treatment for my child, and in the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the Boys & Girls Clubs to hospitalize, secure proper treatment for, and order injection and/or surgery for my child as named above.
I hereby give permission for the Boys and Girls Club staff to take pictures of my child while on the field trip and use those pictures for any Boys and Girls Clubs related media.