I hereby consent for my child (or myself if 18 or older) to be photographed and/or videoed for Coda Mountain Academy. The resulting photographs or videos may be used without compensation to me by Coda Mountain Academy, or third parties for publications (including web sites, advertising, Facebook and/or publicity purposes) at the discretion of Coda Mountain Academy. I waive the right to inspect or approve the finished photograph, video and/or publication use.

We will be serving breakfast and a mid-morning snack. Please indicate below if your child has any allergies or dietary restrictions.

I, the undersigned, am the parent or legal guardian of this minor and have given my consent for him/her to participate in activities hosted by Coda Mountain Academy. In the event of injury, accident, illness, or other emergency while participating in any Coda program or camp, I consent to any reasonable medical treatment as deemed necessary by a licensed physician, emergency medical technicians, nurses, and laboratory technicians. In the event any treatment is required, which a physician and/or hospital personnel refuses to administer without my consent, I hereby authorize a Coda associated adult to give such consent for me, if I cannot be reached at one of the numbers listed above, or because of an emergency in which there is no time or opportunity to make a telephone call. In the event it becomes necessary for Coda personnel to give consent for me, I agree to hold such person, other associated adults, and Coda Mountain Academy free and harmless of claims, demands, or suits for damages which may arise from the giving of such consent. I further authorize disclosure of medical information by a treating physician to the camp director or associated adult supervisor as permitted by The Health Insurance Portability and Accountability Act of 1996 (HIPAA). I also acknowledge that I accept to be ultimately responsible for the cost of any medical care whether or not the cost of that medical care will be reimbursed by my health insurance provider. I understand that although the students will be supervised by Coda Mountain Academy staff, I assume the risk of my student’s participation in the event and transportation to and from the event, if applicable. I acknowledge that I will not seek to have Coda Mountain Academy held liable in the event that any accident, injury, loss of property, or any other circumstance or incident occurs during or as a result of my child’s participation in any Coda programs or camps. This release of liability includes accident, injury, loss or damages to the student, as well as, to other individuals or property which may result from the student’s participation in the event. I hereby release and agree to hold harmless Coda Mountain Academy, its officials, agents and employees, from any claims arising out of my child’s participation in this program/event.