To the best of my knowledge, my child/participant is capable of participating safely in the Program/Event and that any activity restrictions, allergies, and medications are listed on this form. As a participant, parent, or guardian I understand and acknowledge that my failure to disclose relevant information may result in harm to participant and/or others during this program/event. By signing my name I represent and warrant that M have provided all materials and important information to the University of Michigan pertaining to Participant's medical, mental and physical condition and that it is accurate and complete. I agree to notify the University of Michigan of any changes in my child's mental, physical or medical condition prior the scheduled program/event.
I give permission to Program/Event staff to provide routine first aid care and in the event of serious illness or injury, I give Program/Event staff permission to seekand authorizeemergency medical treatment. I hold harmless and agree to indemnify the Program/Event and the University of Michigan from any claims, causes of action, damages and/or liabilities arising out ofor resulting from said medical treatment. lfurther agree to accept full responsibility for any and all expenses,including medical expenses that may derive from any injuries to my child that may occur during his/her participation in this Program/event.
Byordisclosing the above medical information it will not be used by University personnel or employees to determine Participant's ability to participate revealing activities. I understand that, if Participant chooses to participate in activities, he/she do so voluntarily and of his/her own accord and the final decision safelyin regarding participation is solely the responsibility of myself and Participant.