College for Kids/Teens Liability Waiver

College for Kids/Teens Liability Waiver

ACKNOWLEDGMENT OF RISK AND WAIVER OF LIABILITY FOR YOUTH PROGRAMS
By my signature, with full knowledge of the facts and circumstances surrounding my child’s participation in the ACTIVITY, I acknowledge that such participation in the ACTIVITY may expose him/her to actions, events, and environments that may be hazardous to his/her person and property. I acknowledge and assume this risk, and hereby release the Metropolitan Community College Area and its employees, Board of Governors, officers, and agents (collectively “College Parties”) from all liability for injury and/or damage to property, and any and all other claims, caused by my child’s participation in the ACTIVITY. College Parties assume no liability or responsibility for injury or property damage that my child may sustain as a result of participation in the ACTIVITY.

I understand that I am solely responsible for any medical costs that may directly or indirectly result from my child’s participation in the ACTIVITY.

I understand and agree that this is a release of liability agreement, and it is intended to be as broad and inclusive as permitted by law. If any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and legal effect.

Signatures
In signing this Acknowledgment of Risk and Waiver of Liability I hereby acknowledge and represent that I have read this document in its entirety, understand it, have full authority to execute this Agreement, and sign it voluntarily.
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Parent/Guardian's Name*

First NameLast Name
Parent/Guardian's Phone Number*

Area CodePhone Number
Parent/Guardian's Email*
example@example.com
Emergency Contact *

First NameLast Name
Emergency Contact's Phone Number*

Area CodePhone Number
Relationship to Child*
By checking the following box, I recognize and acknowledge that the college may record my child’s participation and appearance in ACTIVITY on any recorded medium (including, but not limited to video, audio, photos) for use in any form. I authorize such recording and release the college to use my child’s name, likeness, voice and biographical material to exhibit or distribute such recordings in whole or part without restrictions or limitations for any educational or promotional purpose.*

Yes, I acknowledge.
By checking the following box, I recognize and acknowledge that students found to be in violation of the Student Code of Conduct may be asked to leave the classroom immediately. Students will need approval from the Continuing Education Department if/when a student is allowed to return to class. The parent/guardian of the student will be notified if the student is not allowed to return to class to arrange for the student to be picked up early. For more information about MCC's student code of conduct policy, visit mccneb.me/codeofconduct.*

Yes, I acknowledge.
Parent/Guardian's Signature*

Clear
Today's Date
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