Thumbs Up High 5K Off-Site Parental/Guardian Authorization and Release Form
Thumbs Up High 5K (“Thumbs Up” or the “Organization”) intends to go off-site of
the Thumbs Up – Elk River location on an occasional/as-deemed-necessary
basis during the Youth Summer Program. Off-site activities will take place in no
more than a two-mile radius from the Thumbs Up – Elk River location. Youth will
be accompanied by a minimum of two adult volunteers and two paid staff
members when walking to an off-site location.
This Authorization and Release form must be completed and returned
before the student will be permitted to participate in off-site activities.
Verbal Authorization or Approval Will Not Be Accepted.
By signing below you authorize your child to walk with Thumbs Up volunteers and staff to off-site locations during the Youth Summer Program on the following dates: July 29th and August 26th.
CONDUCT DURING FIELD TRIP ACTIVITY
I understand that my student’s participation in the activity is a privilege, and not a
right. I acknowledge that I have spoken with my student about my student’s need to
comply with the specific rules and requirements established for this activity; all
Thumbs Up policies and procedures; rules of conduct set forth in the Student Code
of Conduct; and, state and federal regulations and laws. I understand that all
Thumbs Up rules and policies apply to my student and the other students during the
course of the field trip. I also authorize Thumbs Up to make the necessary
arrangements, plans, and precautions that Thumbs Up deems appropriate for the
care and supervision of the student during the trip. Thumbs Up reserves the right
to determine, in its sole discretion, whether or not to allow my student to participate
in this field trip activity.
OFF-SITE PERMISSION AND RELEASE
_________I give permission for my student to walk to and from the activity by such
arranged by Thumbs Up. I also understand that I have the ability to refuse to sign
this Form. In addition, if I refuse to sign this form, my student will not be permitted
to participate in the activity.
_________I also understand that this activity may expose my student to some
risks, and I assume any such risk that may arise. I accept full responsibility for any
and all medical expenses for any injuries that might occur to my student by reason of
his/her participation.
By signing this form, however, I hereby knowingly and voluntarily waive, release
and discharge Thumbs Up, its Board members, directors, officers, employees,
and volunteers (“released parties”) from and against any and all claims, demands,
actions, complaints, suits, losses, judgments, or any and all other forms of liability
(including but not limited to, attorneys’ fees and costs) made or asserted against
any of the released parties, or that any of the released parties may incur or sustain
relating to or arising out of (a) my student’s failure to comply with local, state, and
federal laws and/or Thumbs Up policies, procedures, and the Code of Conduct; (b)
any loss, damage or injury caused to or by my student; or,(c) any transportation of
my student in relation to this activity. I also agree to indemnify and hold harmless the
released parties from any of these released claims, including any and all related
costs, attorney fees, liabilities, settlements, and/or judgments.
I confirm that I have carefully read this AUTHORIZATION AND RELEASE and
understand and agree to its terms knowingly and voluntarily. I also confirm that I
am the parent or legal guardian of the student or I am a student 18 years or older, am authorized by law to sign this AUTHORIZATION AND RELEASE for and on behalf of myself, any other parent of my student, and the student.