Authorizations- Please read carefully
Participation
- I give permission for my child to participate in all activities, including field trips and swimming, and to be transported as authorized by the City of Fort Myers S.T.A.R.S. Division.
- I give permission for the City of Fort Myers S.T.A.R.S. Division to use any pictures of my child for future promotional purposes.
Medical Treatment
I hereby give permission for my child to be given cardiopulmonary resuscitation (CPR) and first aid treatment by a qualified staff member of the City of Fort Myers S.T.A.R.S. Division in the event of emergency, I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I further consent to the disclosure of health information and to the medical, surgical and hospital care treatment and procedures (including, but not limited to, administration of necessary anesthetics, tests, x-ray examinations, transfusions, injections, drugs) to be performed for my child by a licensed physician or hospital selected by the City of Fort Myers S.T.A.R.S. Division Manager when deemed immediately necessary or advisable by the physician to safeguard my child’s health.
Release from Liability
As a participant in the City of Fort Myers S.T.A.R.S. Program(s), I acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries including loss of life, damages or loss which my child may sustain because of participating in any and all activities connected with or associated with such program. I agree to waive and relinquish all claims, fully release and discharge and agree to indemnify and hold harmless and defend the City and its officers, agents, and servants and employees from any and all claims resulting from injuries, including loss of life, damages and losses sustained by me arising out of, connected with, or in any way associated with the activities of the program. I have read the City of Fort Myers S.T.A.R.S. Division Program Rules and Regulations. I realize that my child may be suspended or expelled for failing to follow the rules.
Assumption of the Risk and Waiver of Liability Relating to
Coronavirus/COVID-19
(Read Carefully Before Signing)
The novel coronavirus, Coronavirus/COVID-19, has been declared a worldwide pandemic by the World Health
By signing this agreement I acknowledge the contagious nature of Coronavirus/COVID-19 and voluntarily assume the risk that my minor child(ren) and I may be exposed to, or infected by COVID-19 while using City of Fort Myers S.T.A.R.S and Recreation facilities or participating in its programs, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by Coronavirus/COVID-19 at or while using City of Fort Myers S.T.A.R.S. and Recreation facilities, or participating in its programs may result from the actions, omissions, or negligence of myself and others, including, but not limited to, City of Fort Myers employees, volunteers, program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my minor child(ren) or myself including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, or expense, of any kind, that I or my minor child(ren) may experience or incur in connection with use of City of Fort Myers S.T.A.R.S and Recreation facilities, and/or while participating in its programs. On my behalf, and on behalf of my minor child(ren)s, I hereby release, covenant not to sue, discharge, and hold harmless the City of Fort Myers, its officers, employees, agents, and representatives, of and from any and all Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the City of Fort Myers, its officers, employees, agents, and representatives, whether before, during, or after participation in any the City of Fort Myers S.T.A.R.S. and Recreation Department program or the use of its facilities. Nothing herein shall be construed to waive or alter the City’s sovereign immunity or the limits, rights, or requirements of Section 768.28, Florida Statutes.
By signing my name below I certify that: (1) I am the Parent/Guardian of the Child participant(s) listed on this
Registration Agreement or I am an adult participant over 18 years of age; (2) I have fully read and understand the above terms and conditions and they apply to Child participant(s) or myself; (3) I understand that I am waiving important legal rights to recover damages for injury and/or property damage; (4) I agree I have been encouraged to seek the advice of my own attorney prior to signing this agreement; (5) I have read and voluntarily signed this agreement; and (6) no oral representations, statements or inducements apart from the foregoing written agreement have been made.
For the protection of my child, I or a designated adult will sign my child out when they leave the City of Fort Myers STARS facility location. I will advise City of Fort Myers STARS Division personnel if my child will be picked-up after 6 pm.
Photo Release:
The applicant hereby gives permission for the City of Fort Myers S.T.A.R.S Division to use, without limitation or obligation, photographs or other media that may include the members’ image or voice to promote or interpret City of Fort Myers S.T.A.R.S. Division