Authorizations- Please read carefully
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.
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.
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.
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