By typing my full name, I give Springfield Promise Neighborhood, Clark County Partners in Prevention, and Project Woman permission to care for my child and make appropriate choices to keep them safe. I understand that in the event medical intervention is needed, every attempt will be made to contact the persons listed on this form.  In the event I cannot be reached in an emergency, I hereby give permission to the physician or dentist selected by the activity leader to secure medical treatment or hospitalization for my child as deemed necessary. I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed.  Coverage by Springfield Promise Neighborhood through its accident policy will be used as a backup for what my family's insurance does not cover. I understand all reasonable safety precautions will be taken at all times by Springfield Promise Neighborhood, Clark County Partners in Prevention, Project Woman and their agents.  I understand the possibility of unforeseen hazards and the inherent possibility of risk.

I, the undersigned and parent/legal guardian of the student identified on this registration form, hereby assume all risks and hazards incidental to the conduct of activities and transportation to and from camp while participating in this program. I do hereby absolve, indemnify and hold harmless Springfield Promise Neighborhood, Clark County Partners in Prevention, Project Woman, their leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the student named on this form.