Should an emergency occur, Eastside or Gwinnett Medical will be the hospital where the child is taken.
If your child's medication meets any of these criteria: A physician's instruction is needed for a nonprescription medication (e.g., the child is underage or underweight per the label instructions); or It is a sample medication without a prescription label, or The nonprescription medication is to be given longer than three consecutive days within a fourteen-day period or is a topical product or lotion that is being used for a skin ailment and is to be given no longer than fourteen consecutive days, or The child is on a modified diet (an entire food group is eliminated), or The medication contains codeine or aspirin. ***The topical product or lotion and the physician's instructions exceed the manufacturer's instructions or use***
I hereby request that my student named above to be allowed to participate in all field trips organized by C.H.O.I.C.E Preparatory Academy. I understand that transportation may or may not be provided by C.H.O.I.C.E Preparatory Academy. In the event transportation is not provided by the homeschool program, transportation will be the parent's responsibility.
· Detailed trip information, including destination, date, time of departure, time of return, purpose, and supervision, should be given in writing to the parents at least two (2) weeks prior to any field trip.
· If any emergency medical procedures or treatment are required during the trip, I consent to the trip supervisor taking, arranging for or consent to the procedures or treatment in his/her or their discretion.
· I agree to release, indemnify, hold harmless or expect reimbursement from C.H.O.I.C.E Preparatory Academy, Inc., its owner, Board of Directors, its members, employees, agents, representatives, successors or assignees, as well as its approved adult trip supervisors from any and all claims, demands, rights, causes of action, liabilities, losses, damages, costs, and expenses (including reasonable attorneys' fees), whether known or unknown, that I, any other parent or guardian of the student named above, the student or any other successor or assignee may have or may allege to have against C.H.O.I.C.E Preparatory Academy, Inc. or which may be brought against C.H.O.I.C.E Preparatory Academy arising out of or in any manner related to the student's participation in the field trip, including but not limited any losses, damages or injuries or the rendering of emergency medical procedures or treatment.
Assumption of Risk Liability Waiver:
On behalf of my minor child, I hereby permit my child to participate in the Homeschool Program at the C.H.O.I.C.E. Preparatory Academy. Furthermore, I hereby warrant that my child and I know the risks associated with participation in C.H.O.I.C.E. Preparatory Academy homeschool activities.
I do hereby agree and consent to my child’s participation in the C.H.O.I.C.E. Preparatory Academy homeschool program. I do assume all risks and hazards which are conducted as part of the associated activities.
I hereby release, absolve, indemnify, and hold blameless C.H.O.I.C.E. Preparatory Academy, its officers, directors, employees, contracted employees, independent contractors, instructors, agents, organizers, and volunteers of any and all liability for damage, injury, or expense of any kind arising out of or connected with my child’s participation in C.H.O.I.C.E. Preparatory Academy homeschool program.
In case of a medical emergency, I understand that my own personal medical plan will be used if available; if not, medical aid may be sought while I am being contacted. In the event of any illness or injury, I hereby consent to whatever examination, diagnosis, or treatment and the hospital care from a licensed dentist, physician, and/or surgeon as deemed necessary for my child’s safety and welfare. I understand that the resulting expenses will be my responsibility and not the C.H.O.I.C.E. Preparatory Academy homeschool program or any affiliates.
As a condition of participation in the C.H.O.I.C.E. Preparatory Academy homeschool program by the student named in this application, I acknowledge that I have read this consent form and knowingly, on behalf of my child, assume all of the risks associated with participating in any way in the C.H.O.I.C.E. Preparatory Academy homeschool program.
I hereby release, to the fullest extent permitted by law, the C.H.O.I.C.E. Preparatory Academy homeschool program and the affiliates from any and all actions, claims, demands, or liabilities that I, my assignees, heirs, distributes, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my son/daughter’s participation in these activities irrespective of whether the same is based on breach of warranty, negligence, strict liability or any other theory or recovery.
Parent/Legal Guardian acknowledges that the C.H.O.I.C.E. Preparatory Academy homeschool program is an in-school program, not a licensed childcare or daycare facility. I have read this agreement and agree to the conditions stated above.
I hereby give permission for my student to be photographed and or videoed by C.H.O.I.C.E Preparatory Academy throughout the homeschool program. I understand that the photos/video will be used for presentations or reports for our donors, promotional purposes, including flyers, newspapers, and the internet. I understand that although my child's photograph may be used for advertising, their identity will not be disclosed. I do not expect compensation and that all photos are the property of the C.H.O.I.C.E Preparatory Academy academic program.
I hereby give permission for the transportation of my child for official homeschool program activities by modes of transportation agreed to by the C.H.O.I.C.E Preparatory Academy field trip organizers.
C.H.O.I.C.E Preparatory Academy or its organizers are not responsible for any lost or damaged personal property, while at the C.P.A center, authorized events, field trips or activities.
Given the COVID-19 environment, the C.H.O.I.C.E. Preparatory Academy is requiring all students participating in the 2021 summer program to adhere to the following safety guidelines and provide the below information in order to reduce the risk or spread of infection. Parent(s) or guardians must acknowledge the following statements to participate in summer programming at C.H.O.I.C.E. Preparatory Academy.
Any activities and programs offered by C.H.O.I.C.E. Preparatory Academy, on-site, will be using this waiver. If your student is involved in more than one program, you need only complete the form once.
I agree to continue to adhere to the above safety guidelines as long as my student participates in the C.H.O.I.C.E. Preparatory Academy programs.
IT IS THE RESPONSIBILITY OF THE PARENT/GUARDIAN TO CHECK THEIR STUDENT PRIOR TO ATTENDING C.H.O.I.C.E. Preparatory Academy, FOR SYMPTOMS OF COVID-19. C.H.O.I.C.E. Preparatory Academy STAFF WILL MONITOR STUDENTS DURING PROGRAMMING FOR SYMPTOMS.
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. However, there remain many unknowns about COVID-19, how it spreads, and its impact on a student.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending C.H.O.I.C.E. Preparatory Academy programming and that such exposure or infection may result in severe illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at C.H.O.I.C.E. Preparatory Academy programming may result from the actions, omissions, or negligence of myself and others, including, but not limited to, C.H.O.I.C.E. Preparatory Academy employees, contractors, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at C.H.O.I.C.E. Preparatory Academy or participation in C.H.O.I.C.E. Preparatory Academy programming (“Claims”). On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless C.H.O.I.C.E. Preparatory Academy, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of C.H.O.I.C.E. Preparatory Academy, its employees, contractors, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any C.H.O.I.C.E. Preparatory Academy programs.