Aurora University 2017 Summer Academic Camp Program Consent Form Assumption of Risk, Release of Liability, and Medical and Media Authorization
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- MEDICAL AUTHORIZATION
- ASSUMPTION OF RISK
- RELEASE and GENERAL LIABILITY WAIVER
- Aurora University 2017 Summer Academic Camp Program Consent Form MEDIA RELEASE
- INDEMNIFICATION and HOLD HARMLESS
- SEVERABILITY
- ACKNOWLEDGEMENT OF UNDERSTANDING
| Aurora University 2017 Summer Academic Camp Program Consent Form
Assumption of Risk, Release of Liability, and Medical and Media Authorization (This form must be signed by a parent or guardian if participant is under 18 years old.) This form must be completed, signed and returned the first day of camp at check-in. Participant’s Printed Name: Date of Birth: Name of Camp: _____________________________________ Camp Dates: _______________ In consideration of the above student being permitted to participate in the Aurora University Academic Camp Program, I, for myself and on behalf of my participating child, if applicable, agree to the terms set forth in this agreement. I am executing this agreement on behalf of myself, my child, my family members, heirs, estate, executors, personal representatives, administrators and assigns. I understand that the use of the term "Aurora University" in this agreement includes its trustees, faculty, employees, agents, volunteers, affiliates, assigns and successors, including those of George Williams College of Aurora University. I understand that this agreement covers the entirety of my/my child’s participation in the residential camp program, including academic activities, recreational activities, field trips, transportation and free time, as well as any optional recreation programs for which consent is given separately (collectively, the “Academic Camp Activities”). MEDICAL AUTHORIZATION: I acknowledge that I am responsible for all medical and other costs arising out of bodily injury or any loss sustained through participation in Academic Camp Activities. I authorize and give my consent to Aurora University camp staff to act in any attempt to preserve my/my child’s health or safety during participation in the Academic Camp Activities, and to act on my/my child’s behalf to secure any hospital, physician, ambulance and/or medical personnel for immediate treatment deemed necessary in connection with the Academic Camp Activities. I understand that should an emergency medical problem arise, an attempt will be made to call the emergency phone number(s) that I have provided. In the event that the emergency contact cannot be reached, I hereby give consent to medical treatment as deemed necessary by a licensed health care professional. ASSUMPTION OF RISK: I understand that participation in the Aurora University camp’s schedule of events will include classroom activities, instruction, tours, field trips, indoor and outdoor recreational programs, group outings, bonfires, and swimming and other lake activities, as well as optional outdoor experiences which will require separate consent. Inherent in the Academic Camp Activities is the possibility of certain risks that can cause injury. I understand that participation will require travel to and from the program sites and various locations within the area. I understand that injury, illness or loss may arise from various factors including but not limited to slips and falls; ticks or insect bites; allergies or other health conditions; my/my child’s actions or those of other participants; vehicle or pedestrian accident; drowning; delayed or improperly administered medical treatment; loss or damage to my/my child’s personal property; or from other known or unknown factors. I agree that my/my child’s participation in the Academic Camp Activities is voluntary and I hereby assume any and all inherent risks of property damage, illness, and personal injury, including serious physical or emotional injury or death. RELEASE and GENERAL LIABILITY WAIVER: I hereby release, waive, discharge and covenant not to sue Aurora University, including its trustees, faculty, employees, agents, volunteers and representatives (in their official and individual capacities), of and from any and all claims, suits, actions, or causes of action (collectively, "Claims") arising out of or related to my/my child’s participation in the Summer Academic Camp Program, including any optional activities for which consent is given, including but not limited to Claims for wrongful death, personal injury, property damage, loss or theft of property and contribution under a joint tortfeasor theory. Aurora University 2017 Summer Academic Camp Program Consent Form MEDIA RELEASE: I hereby consent to the use of my/my child’s photograph, image, voice, written and/or verbal statements (“materials”) by Aurora University in its publications, videotaping, advertisements, brochures, websites, etc. I agree that Aurora University may use my/my child’s photo with or without my/ my child’s name for lawful purposes including the above. I further acknowledge that there is no agreement or promise on the part of the university to compensate me/my child in any way for the use of my/my child’s materials in said manner. I hereby release the university from any and every claim, demand, right, or cause of action of whatever kind or nature, either in law or in equity, arising from the use of my/my child’s materials. I also authorize the use of any information I or my child provides to the university with regard to my/my child’s personal life and accomplishments for use in promotional materials. INDEMNIFICATION and HOLD HARMLESS I agree to indemnify and hold Aurora University harmless form any and all claims, actions, suits, procedures, cost, expenses, damages and liabilities, including attorney’s fees, brought as a result of my/my child’s involvement in this Program and to reimburse Aurora University for any such expenses incurred. SEVERABILITY I understand that this agreement is intended to be as broad and inclusive as permitted by law, including the law of the State of Illinois. In the event any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect. ACKNOWLEDGEMENT OF UNDERSTANDING: I have fully and carefully read this agreement and understand its terms. I UNDERSTAND THAT BY SIGNING THIS AGREEMENT, I, FOR MYSELF AND MY PARTICIPATING CHILD, AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY/MY CHILD’S RIGHT TO SUE AND/OR SEEK RECOVERY FROM AURORA UNIVERSITY FOR INJURIES AND CLAIMS RELATED TO MY/MY CHILDS’ PARTICIPATION IN THIS ACADEMIC CAMP PROGRAM AND ACADEMIC CAMP ACTIVITIES. I am signing this agreement freely and voluntarily, and acknowledge that my signature constitutes a complete and unconditional release of all liability to the greatest extent allowed by law. ___________________________________ ________________________________ ___________________ Participant's Signature Printed Name of Participant Date ___________________________________ ________________________________ ___________________ Parent/Guardian Signature Printed Name Date Directory: documents -> stem documents -> Concept stage documents -> The great global switch-off documents -> Nonprofit grant application documents -> The Truth about the Rwandan Genocide documents -> Annual InStructional unit plan documents -> Chaos equipment included stem -> Board of education linda Schultz, President Linda McCain, Vice President Download 15.21 Kb. Share with your friends:
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