Authorized Dismissal Sample Clauses

Authorized Dismissal. My child is at least 16 years of age and will be responsible for his/her own transportation to and from the program. My child may sign himself/herself out at the end of the program activities. *Please note that only the enrolling parent will be permitted to complete this form.

Authorized Dismissal. My child is at least 16 years of age and will be responsible for his/her own transportation to and from the program. My child may sign himself/herself out at the end of the program activities. *Please note that only the enrolling parent will be permitted to complete this form. Name: Address (Street, City, Zip): Phone: Student ID Number (if applicable) Company Name: Policy Number: This person will be contacted in case of any emergency. Name: Phone:

Authorized Dismissal. My child is at least 16 years of age and will be responsible for his/her own transportation to and from the program. My child may sign himself/herself out at the end of the program activities. Gender: Date of Birth: I acknowledge, 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 youth program may involve risks and dangers, both known and unknown, and have elected to allow my Child to participate 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 the Board of Regents of the University System of Georgia, Fort Valley State University, its Administration, Faculty, Staff, Student Leaders, the Program Staff, and all other officers, directors, employees, volunteers and agents (hereafter “FVSU”) from any and all liability as to any right of action that may accrue to my 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 Camp. This agreement is binding on my heirs and assigns. I, on behalf of my Child, furthermore release, indemnify and hold harmless FVSU from and against any and all liability, actions, debts, claims 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 FVSU accepts no responsibility for my Child’s personal property. In the event of an accident or serious illness, I hereby authorize representatives of FVSU to obtain medical treatment for my Child on my behalf. I hereby hold harmless and agree to indemnify FVSU from any 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 exp...