Summer Camp Authorization and Waiver Information

A. Parent’s Authorization: The medical history provided is correct to the best of my knowledge, and the student herein described has my permission to engage in all activities, unless otherwise noted by me. I give permission to the physician or hospital selected by a medical representative of Cuyahoga Community College to hospitalize, secure proper treatment for, and to order medications, injections, anesthesia, or surgery for my child.

B. Medical Waiver: My son/daughter is in good health and can participate in the activities of Cuyahoga Community College East Campus Athletics and Recreation Sports Camp.

C.. Indemnification by Guardian Applicant: The undersigned guardian of the above named student agrees to save and indemnify Cuyahoga Community College, its employees, and its agents, and the Cuyahoga Community College East Campus Athletics and Recreation Sports, its agents, sponsors, and employees against any liability, claims, judgments, or demands for damages arising as a result of injuries sustained while attending or participating in Cuyahoga Community College East Campus Athletics & Recreation Sports.

D. Photograph/Video Release: I hereby permit Cuyahoga Community College to publish photographs and /or videotapes for promoting University programs, which include the above-named student. I hereby release all right, title, and interest I may have in said photograph/video.

E. Cuyahoga Community College reserves the right to dismiss any participant whose behavior is disruptive to the program. Disruptive behavior can be described as conduct that prevents the execution of class activities or endangers program participants and/or staff.

I certify as a parent or guardian of the above-named student that together we have reviewed all regulations in A, B, C, D and E. pertaining to Cuyahoga Community College and understand that failure to abide by these regulations will result in immediate dismissal from the program without a refund.

CUYAHOGA COMMUNITY COLLEGE DISTRICT
INFORMED CONSENT, RELEASE OF LIABILITY AND INDEMNIFICATION
“Summer Camp Activities and Field Trips”

I understand that the Student will be attending various field trips (“Activity”) as part of their voluntary participation in "Summer Camp programming". This Activity may involve inherent dangers, hazards and risks in which Student may be exposed, the RISK OF PERSONAL PROPERTY DAMAGE, BODILY INJURY, AND POSSIBLE DEATH. Understanding fully that these dangers, hazards and risks may be present, I give permission for Student to participate in the Activity.

In consideration for Student’s participation in the Activity, he/she agrees to follow the rules and regulations established by the Cuyahoga Community College District (“College”), for safety. I hereby, on behalf of Student, Student’s heirs, executor, administrator, and assignees, assume all risks associated with Student’s participation in the Activity and agree to hold harmless the College its trustees, officers, employees, agents, and representatives, volunteers, and all other entities acting in any capacity on its behalf for any and all liability, actions, causes of action, losses, debts, claims or demands of any kind and nature that may result from or in connection with my students participation in the Activity, and I release, waive, forever discharge, and covenant not to sue the College, its governing board, officers, agents, employees, and any students acting as its employees (“Releasees”), from and against any and all liability for any harm injury, damage, claims, demands, actions, causes of action, costs, and expenses of any nature that I may have or that may hereafter accrue to me, arising out of or related to any loss, damage, or injury, whether caused by the negligence or carelessness of the Releasees, or otherwise, while in, on, or participating in the Activity.

I assert that there are no health-related reasons or problems which preclude or restrict Student’s participation in the Activity and that I have adequate health insurance necessary to provide for and pay any medical costs as a result of injury, if applicable.

I also understand and agree that the College may not have medical personnel available at the location of the Activity. I understand and agree that the College is granted permission to authorize emergency medical treatment, if necessary, and that such action by Releasees shall be subject to the terms of this INFORMED CONSENT, RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT (the “Agreement”). I understand and agree that the College assumes no responsibility for any injury or damage, which might arise out of or in connection with such authorized emergency medical treatment. In case of an emergency, I give permission for the Student to receive medical treatment.

I agree that if any term or provision of this Agreement shall be held illegal, unenforceable, or in conflict with any law, the validity of the remaining portions shall remain in full force and shall not be affected thereby. I further understand that this Agreement shall be construed in accordance with the laws of the State of Ohio.

I understand that I sign this Agreement as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written statement, have been made. I further state that the Student is a minor and that I am the parent or guardian of the Student and that I am competent to sign this Agreement; and that I execute this Agreement for full, adequate, and complete consideration fully intending to be bound by the same.

THIS IS A RELEASE OF YOUR RIGHTS. READ CAREFULLY BEFORE SIGNING.