Medical Release and Authorization
In the event of a medical emergency, the undersigned parent(s)/ guardian(s), hereby grants authorization to JAC of HeArts, and its representative, to employ any legally licensed physician or health care facility on behalf of each of the undersigned, and to direct and/or order emergency medical treatment for the named participant(s). Each of the undersigned further agrees that neither JAC of HeArts nor any of its representatives shall be liable under any circumstances to anyone for exercising the foregoing authority in the event of the emergency.
I hereby give my permission for my child/ children to participate in all JAC of HeArts program activities. I, the undersigned, as parent or legal guardian of the minor child/ children listed on this application, hereby assume full responsibility for all risks of injury or loss which may result from my child’s participation in this activity and hereby agree to hold harmless, release, and discharge JAC of HeArts members or employees from and waive any and all claims and demands whatsoever which the undersigned and any third person of any accident, illness, injury or death of any person unless caused by the negligence of JAC of HeArts, employees, and/or agents.
I understand that it is my responsibility to inform JAC of HeArts staff if my child has a medical condition, allergy, physical, or other disability or condition that may require special attention. I agree to indicate such conditions on the Medical Release Form herein and discuss the situation in person with JAC of HeArts staff prior to attending camp.