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Waiver

YOUTH AND ADULT WAIVER AND RELEASE/ASSUMPTION OF LIABILITY FORM

LIGHTHOUSE ACADEMY

Authorization to participate: This form is to allow myself and/or child(ren) to participate in various activities sponsored by Lighthouse Academy.

 

Certification of Capability to Participate and Understanding of Risks/Assumption of Risks:

My signature on this form is my certification that my child is physically capable of engaging  in the activities or events described above, and I hereby give my consent for my child to  engage in all activities or events. Further, I acknowledge that I understand the risks posed to  my child engaging in any activity or event. In exchange for allowing my child to participate  in school-sponsored activities or events, I hereby assume all risks of injury or damages  including medical, of whatever type or form associated with my child's participation in these  activities or events.

 

I acknowledge and fully understand that each member/participant will be engaging in  activities that involve risk of serious injury, including permanent disability and death, and  severe social and economic losses which might result not only from their own actions,  inactions, or negligence but the action, inaction, and negligence of others, or the condition of  the premises or of any equipment used. Further, that there may be other risks not known to us  or not reasonably foreseeable at this time.

 

Consent to Treatment:

My signature on this form also constitutes my consent to medical  providers diagnosing or providing medical treatment to my child at my expense in the event of  injury or illness requiring emergency or other medical treatment while involved in these  activities or associated with the activities. My child is covered with a health insurance policy with [name of insurance carrier],  policy # [policy number].  

A photocopy of this medical authorization shall serve as effectively as an original.

I waive any claims or causes of action, including attorney's fees, I might have against Scholars  Inspired to Lead/Inspired to Learn for allowing my child to participate in reliance upon this  agreement. I agree to indemnify and hold Scholars Inspired to Lead/Inspired to Learn  harmless in the event they provide medical treatment or are subsequently sued for injuries to  my child during this event.

Release of Liability:

I release, waive, discharge and covenant not to sue Lighthouse Academy, its affiliated clubs, their respective administrators, directors, agents, and other employees of the  organization, other members/participants, sponsoring agencies, sponsors, advertisers, and if  applicable, owners and lessors or premises used to conduct the event, all of which are  hereinafter referred to as “releases,” from any and all liability to each of the undersigned, his  or her heirs and next of kin for any and all claims, demands, losses or damages on account of  injury, including death and damage to property, caused or alleged to be caused in whole or in  part by the negligence of the releases or otherwise.

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY.

PRINTABLE WAIVER
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