I give full permission for my child(ren) to participate in the activities while attending a support group conducted by Dillon International, Inc.,("Dillon") from October 2022 to March 2023. I fully and unconditionally release, remise, discharge, and hold harmless Dillon (including its parent entities, affiliates, their current and former officers, directors, members, agents, and employees), together with providers of services, host family, and volunteers from any and all claims, charges, complaints, demands, actions, causes of action, suits, damages, liabilities, and expenses (including attorneys’ fees) however caused, that might arise from my child(ren)’s participation in camp.
I hereby authorize Dillon International to use pictures of myself or my child(ren) taken in a photograph, digital image, videotape, motion picture, and/or testimonial (written words). I grant permission to use a camper’s photograph or other media for display on the Dillon website, social media account, and/or inclusion in Dillon publications. I understand that Dillon will not put any identifying information in the photo or video.
In case of emergency, I understand every effort will be made to contact me, my spouse, or my relative. In the event I cannot be reached, I hereby give my permission to the physician selected by the Coordinator for support groups to secure proper treatment, including hospitalization, anesthesia, surgery, or medications for my child.
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious. As a result, federal, state, and county governments, along with federal and state health organizations recommend social distancing and wearing masks. The liability insurance covering this event requires social distancing and wearing masks.
Dillon International, Inc. has put in place preventive measures to reduce the spread of COVID-19, but Dillon International cannot guarantee that you or your child(ren) will be not become infected with COVID-19.
On my behalf and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless Dillon International, their employees, agents, volunteers, and representatives from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to support groups. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Dillon International, their employees, agents, volunteers, and representative whether a COVID-19 infection occurs before, during, or after participation in support groups.
COVID-19 Disclosure Agreement
I willingly agree to contact Dillon International if any camp participant included in this application begins displaying symptoms of COVID-19 or receives a diagnosis of COVID-19 within 14 days of being present at support groups. I further understand that this information is to be used for contact tracing purposes only and that the affected individual’s identifying information will be kept confidential and will not be shared with other camp participants.