PLEASE READ THESE TERMS CAREFULLY BEFORE SIGNING. This is a legally binding form. This fully signed form must be submitted by a parent or legal guardian before any minor child is allowed to participate in the above referenced program.
I, wish for my minor child (hereafter “Child”) to participate in the above referenced program (hereafter “Program”) on the date(s) and location indicated above and, in consideration for my Child’s participation, I hereby agree as follows:
I acknowledge, agree, understand and appreciate that as part of my Child’s participation in the Program there are dangers, hazards and inherent risks to which my Child may be exposed, including the risk of serious physical injury, temporary or permanent disability, and death, as well as economic and property loss. I further realize that participating in the Program may involve risks and dangers, both known and unknown, and have elected to allow my Child to take part in the Program. Therefore, I, on behalf of my Child, voluntarily accept and assume all risk of injury, loss of life or damage to property arising out of training, preparing, participating and traveling to or from the Program.
I, on behalf of my Child, hereby release Trevecca Nazarene University, its Board of Trustees, administration, faculty, staff, student leaders, and all other officers, directors, employees and agents from any and all liability as to any right of action that may accrue to me, my Child, my Child’s heirs or representatives for any injury to my Child or loss that my Child may suffer while training, preparing, participating and/or traveling to or from the Program. This agreement is binding on my heirs and assigns.
I, on behalf of my Child, furthermore release, indemnify and hold harmless Trevecca Nazarene University from and against any and all losses, liability, actions, debts, claims, costs (including reasonable attorney fees) and demands of every kind whatsoever, specifically including, but not limited to, any claim for negligence or negligent acts or omissions and any present or future claim, loss or liability for injury to person or property that my Child may suffer, for which my Child may be liable to any other person, that may or does arise out of my Child’s participation in the Program. I understand that Trevecca Nazarene University accepts no responsibility for my Child’s personal property.
In the event of an accident or illness, I hereby authorize representatives of Trevecca Nazarene University to obtain medical treatment for my Child on my behalf. I hereby hold harmless and agree to indemnify Trevecca Nazarene University from any costs, claims, causes of action, damages and/or liabilities, arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries to my Child that may occur during his/her participation in the Program.
Participants may carry personal "epi" pens and inhalers during activities for self-administration.
I understand that I must provide the medicine in its original pharmacy container labeled with the participant’s name, medicine name, dosage, and timing of consumption.
I understand that it is my responsibility to instruct the participant on how to administer the prescribed medication. For medicine that the participant cannot self-administer, I must make arrangements with a third-party health care professional unaffiliated with the University in advance of the Minor’s arrival. In no event will a University health care professional be responsible for such administration.
In addition to the above release, I hereby authorize the following over-the-counter medications to be used by my child at the University’s discretion.
Ointments for minor wound care, first aid as directed. (antiseptic, anti-itch, anti-sting, topical antibiotic, sunburn) Tylenol/Acetaminophen as directed Aspirin/Ibuprofen as directed Throat lozenges and or spray as directed for sore throat Micatin or anti-fungus treatment as directed for athlete’s foot. Kaopectate or Imodium for diarrhea as directed. Milk of Magnesia, Pepto Bismol or Mylanta for upset stomach or nausea as directed. Rolaids or Tums for acid reflux, heartburn or indigestion as directed. Benadryl for swelling, hives, allergic reaction, as directed. Actifed or Sudafed as directed for nasal congestion or allergy relief per instructions. Visine or other eye drops for minor eye irritation Hydrocortisone ointment as directed for mild skin irritations, poison ivy, and insect bites. Sunscreen Bug Repellent
I understand that I must provide the medicine in its manufacturer’s container and labeled with the participant’s name, dosage, and timing of consumption.
I understand that it is my responsibility to instruct the participant on how to administer the Over-the Counter medication. For medicine that the participant cannot self-administer, I must make arrangements for myself or a with a third-party health care professional unaffiliated with the University in advance of the Minor’s arrival. In no event will a University health care professional be responsible for such administration.
I understand that Trevecca Nazarene University does not provide medical insurance to cover emergency care or medical treatment of my Child.
Emergency Contact Information
I understand and consent that the Trevecca Nazarene University may photograph, video record, and/or audio record my Child, while my Child is participating in a Trevecca Nazarene University program or sponsored program. I release all claim to such audio and video recordings or photographs or images of my Child to Trevecca Nazarene University for use in any manner deemed appropriate, without compensation to me or my Child.
I understand that my child will be a participant in a Program affiliated with Trevecca Nazarene University, and I hereby give permission for him/her to participate.
I understand that my child will be provided with the orientation and training necessary, and as needed, for the safe and responsible participation in the Program.
I understand that my child may participate in physical activity. I represent and warrant that my child is in good physical condition and has no physical, health related or other problems which would preclude or restrict his/her safe participation in this Program or otherwise render his/her participation dangerous or harmful to him/her or others, and that he/she is allowed to participate in physical activity.
This AUTHORIZATION AND RELEASE contains the entire agreement regarding the subject matter contained herein between the parties to this agreement and the terms of this AUTHORIZATION AND RELEASE are contractual and not a mere recital. The information I have provided is disclosed accurately and truthfully. I have been given ample time or opportunity to read this document and I understand and agree to all of its terms and conditions. I understand that I am giving up substantial rights (including my right to sue), and acknowledge that I am signing this document freely and voluntarily, and intend by my signature to provide a complete and unconditional release of all liability to the greatest extent allowed by law. My signature on this document is intended to bind not only myself and my Child but also the successors, heirs, representatives, administrators, and as signs of myself and my Child.