LPS Summer Clinic Registration, WAIVER, RELEASE AND ASSUMPTION OF RISK (Parent)
This form MUST be filled out PRIOR to your student using LPS Facilities.
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Waiver
I am over the age of 18 and I am a parent and/or legal guardian for the children listed below.  I am signing this document below on behalf of myself and my children who are named below.

I understand that the Lincoln Public Schools is willing and prepared to make available for use by LPS students certain LPS facilities, including but not limited to gyms, indoor practice areas, weight rooms, wrestling rooms, hallways, restrooms, outside practice fields and conditioning spaces, and associated facility areas (the “LPS facilities”).  I am fully aware of the specific risks and dangers associated with using all LPS facilities.  I also understand and am aware that due to the size and spacing of gyms, internal practice areas and rooms, weight rooms, wrestling rooms, hallways, restrooms, outside practice fields and conditioning spaces, and other areas of LPS facilities, the possibility of closer contact between students, supervisors, staff, or coaches, the nature of physical exertion and conditioning workouts, and other factors involved with using LPS facilities, that there is a significant risk that my children could be exposed to and could contract the virus which causes COVID-19 or incur other injuries or communicable health conditions.

I understand that using the LPS facilities is completely voluntary, at my and my child or children’s own risk.  I and my child or children are assuming the risk that by using the LPS facilities, I or my child or children could be exposed to and could contract the virus which causes COVID-19 or incur other injuries or communicable health conditions, and I accept this risk and nonetheless voluntarily choose to allow my child or children to use the LPS facilities.  I agree that Lincoln Public Schools is not responsible in any manner for (1) my or my child or children’s usage of LPS facilities, (2) any personal injury to me or my child or children occurring as a result of using LPS facilities hereunder, including but not limited to physical injury or exposure to or contraction of the virus which causes COVID-19, or (3) property damage to me or my child or children occurring as a result of using LPS facilities.  I further understand that I am solely responsible for any personal injury or property damage caused by me or my child or children as a result of the usage of any LPS facilities.

In consideration of my children being allowed to use LPS facilities during the COVID-19 pandemic and for other good and valuable consideration, receipt of which is hereby acknowledged, I, on behalf of myself and my undersigned child or children and all others who may claim by, under, or through myself, do hereby release, covenant not to sue and waive any and all claims, causes of action, and lawsuits that I, my child or children, or any other guardian(s) may have or may accrue against the Lincoln Public Schools, its board of education, officers, administrators, teachers, coaches, agents, representatives, and insurers, whether for personal injury, including exposure to or contraction of the virus which causes COVID-19, or property damage, whether known or unknown, in any way arising out of or resulting from my and/or my child or children’s use of any LPS property or LPS facilities during the COVID-19 pandemic, including from the date signed below through the summer months until August 31, 2022.

I understand and agree that my signature below represents a signature on behalf of myself and each of my children.
Please Complete One Form for each Child
Student ID #
Student Last Name *
Student First Name *
Grade for the  2024-2025 school year *
School the student will attend during the 2024-2025 school year? *
Emergency Contact *
Emergency Contact Phone # *
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