Summer Adventure/Club 1114 Waiver of Liability

Authorization Waiver of Liability and Disclaimer Form

1. GENERAL AUTHORIZATION

I, the parent/guardian grant permission for my child/dependent to participate in the Summer Enrichment Program (Summer Adventures or CLUB 1114). I recognize, for myself and my child that these activities involve risks of injury and my child may be subject to injury by participating in Summer Enrichment Program activities. I am enrolling my child with the knowledge of potential injury to my son/daughter and expressly agree to assume the risk of injury on behalf of my child. Further, I consent to and authorize the use and reproduction, for any purpose and without compensation, of all photographs and video taken of my child while enrolled in the Summer Enrichment Program.

2. MEDICAL AUTHORIZATION

I further authorize the Montrose Recreation District, at the discretion of any supervising employee, to apply sun screen and obtain medical care for my child and/or transport or arrange to transport him/her to any medical clinic or hospital if medical attention appears to be necessary. I understand that upon transporting my child to any such medical facility that the Montrose Recreation District shall not have any further responsibility for my child. I understand that the Montrose Recreation District will make an effort to locate my child’s contact phone numbers in the event of such an emergency, but if it is not possible to locate a contact person, I further authorize a licensed physician, dentist or other medical care provider to carry out any emergency medical care of my child. I agree to pay all costs associated with such medical treatment and related transportation for my child.

3. WAIVER OF LIABILITY AND DISCLAIMER

In consideration of my son’s/daughter’s participation in the Summer Enrichment Program (Summer Adventures or CLUB 1114) of the Montrose Recreation District, I, as parent or guardian of named child, my heirs, executors, administrators and assignees, waive, release and discharge any and all rights any claims or damages against the Montrose Recreation District and/or its sponsors for all claims arising or resulting from traveling, participating and/or being involved in the Summer Enrichment Program. I attest and verify that I have full knowledge of the risks involved in the Summer Enrichment Program, and that I will, on behalf of said child, assume and will pay medical or emergency expenses in the event of accident, illness or other incapacity regardless of whether an emergency contact person has authorized such expenses, and that my son/daughter is physically fit and sufficiently trained to participate in the Summer Enrichment Program.

BY COMPLETING REGISTRATION FOR THIS PROGRAM, I CERTIFY THAT I HAVECAREFULLY READ, CLEARLY UNDERSTAND AND VOLUNTARILY AGREE TO THIS GENERAL AUTHORIZATION, MEDICAL AUTHORIZATION, AND WAIVER OF LIABILITY AND DISCLAIMER FORM AND AGREE TO ALL OF THEIR TERMS.