Moral Reconation Therapy (MRT)
I understand that I am participating in the program affixed to the stop of this document in Johnson County, Indiana as ordered or requested.
I acknowledge that I have fully and completely disclosed any physical ailment I have that may limit my participation.I release the County of Johnson, Indiana, any other county where I am to participate in the this program and any elected official, employee, participating agency, and any person or entity associated with the this program or Johnson County Community Corrections and/or the Johnson County Community Corrections Advisory Board members, of any liability for any injuries and/or accidents that may occur as a result of my being court ordered or requested to participate in this program.
I also understand that because I have been court ordered or requested to participate at no pay through the above listed program, and even though I may be participating under the instruction and on the premises of a separate not for profit agency, I AM NOT COVERED for Worker's Compensation Insurance, which is provided to paid employees in the State of Indiana pursuant to Indiana law, while I am participating in this program as court ordered or requested.
I understand that if I have medical coverage, I will inform Community Corrections of this insurance (i.e. policy number, company, policy holder name, etc, and that if I am injured in any way while participating in the above listed program, I will inform the program instructors of the injuries and that I will file all insurance claims with my insurance company. If my insurance company does not pay the cost of my injuries in full, or if I do not have medical insurance at all, I will send the claims to Juvenile Community Corrections and the Juvenile Community Corrections insurance company will review the costs of the claims and consider payment.
I/we, the undersigned, hereby acknowledge that I have been advised that my child's participation in the above listed program may be covered by news or other form of media. While I understand that no names, faces or voices will be photographed, recorded or filmed by any media devices, said media personnel may be present and may record, film or photograph the program in such a way that no identities may be revealed.
I further acknowledge by signing this document that I have read or have had read to me the above and understand it, and that I am signing this document freely and voluntarily.