We, parent/child, hereby agree with Take Ch9rge on the following:
1. The Student’s participation in the program, and all future Take Ch9rge programs/events, is voluntary and the Student assumes all risks ad responsibilities concerning participation, including all activities the Student participates in, including but not limited to support group, field trips, evening, and/or physical recreation activities. The Parent/Guardian understands that there may be some risk of injury to the Student in these activities, but still desires that the Student participate.
2. The Student and Parent/Guardian consent to allow Take Ch9rge, its employees and agents to render medical treatment to the student if such treatment should be necessary during the course of the program, and all future Take Ch9rge programs/events, including but not limited to support group, field trips, evening, and/or physical recreation activities. The Parent/Guardian is solely responsible for the cost of such treatment for the Student. It is understood that any agent taking action hereunder shall notify the Parent/Guardian of the same as soon as possible and that Take Ch9rge should not delay obtaining any necessary medical treatment while seeking to notify the Parent/ Guardian. The Student and Parent/ Guardian authorize all physicians and other medical care providers, including hospitals, to provide medical care to the Student in accordance with the direction of Take Ch9rge, its employees and agents.
3. In consideration of the Student’s acceptance into and participation in the program, and all future Take Ch9rge programs/events, the Student and the Parent/Guardian hereby agree to indemnify, hold harmless and release Take Ch9rge, its officers, employees, volunteers, and agents from liability resulting from any illness, injury, damage to property, or other consequences directly or indirectly related to the Student’s participation in the program and all future Take Ch9rge programs and events.
4. The Student agrees to abide by all appropriate statutory laws and all rules and policies of Take Ch9rge and/or the program sponsor. Failure to abide by the foregoing may result in termination of the Student’s ability to continue in the program, and all future Take Ch9rge programs/events.
5. Parent/Guardian agrees that should the Student choose to end participation in the and Take Ch9rge program or misses more than 3 consecutive classes, the program will be non-refundable.
6. I am the parent/legal guardian of the child named above, who is under the age of 18. I hereby provide permission to and Take Ch9rge to include certain personal information about my Son/daughter/grandson/granddaughter/ward in connection with support of and Take Ch9rge programs/events including publication in: promotional materials, press releases, newsletters, web site contents, and in all media now known or hereinafter devised in perpetuity. I release Take Ch9rge and it’s agents and employees from any claims of infringement, invasion of privacy, defamation or misappropriation arising from the use of the information provided by me in the permitted manner.
Disclosure: Some of the topics discussed during the camp may elicit strong emotions from participants. We will discuss a range of topics in various media forms (i.e., music, video, print). Some material may contain strong language. Professional counselors and therapists are available if such feelings are produced at any time.