2016 Teen/Child Assumption of Risk and Release

2016 Assumption of Risk and Release Form
IN CONSIDERATION of my child being permitted to participate in the Day Camp and Children's Programs at the Summer Celebration at Lipscomb University, I, the undersigned parent/guardian, in full recognition and appreciation of the dangers and hazards inherent in participating in such activity and in the circumstances to which my child may be exposed during participation in the activity, do hereby agree to assume all the risks and responsibilities surrounding and pertaining to my child's participation in the activity; and
FURTHER, I do for myself and my child's personal representative(s), heirs and assigns, hereby agree to defend, hold harmless, indemnify, release and forever discharge Lipscomb University, and all its officers, agents, and employees from and against any and all claims, demands and actions, or causes of action, on account of damage to personal property, personal injury, or death which may result from my child's participation in said activity.
FURTHER, I hereby grant permission to the director and/or his designee to seek and/or administer appropriate medical aid to my child in the event of an emergency.
IN WITNESS WHEREOF, I have caused this Assumption of Risk and Release to be executed on this date.
 
 
List all relevant Cell Phone #'s of adults who will be able to help in case of emergency. We MUST be able to contact you while your children are with us. Thanks!
PLEASE INDICATE WHAT PROGRAMS YOUR CHILD WILL BE ATTENDING.
 
 
 
 
 
 
List any medical conditions, allergies or other health-related issues the Director MUST know about in order to make day camp safer and better for your child. Please be specific about what foods he or she is allergic to and/or any necessary accomodations your child will need for medical conditions.