1. Risks. I, the parent of the child named above, permit my child to take part in all activities. I acknowledge and expressly agree to assume the risks on behalf of the child. 2. Medical Authorizations and Medical Insurance. I authorize Jordan Kurth to obtain medical care for the child and/or transport or arrange to transport the child to an appropriate medical facility if medical attention appears to be necessary. I further authorize a medical care provider to carry out any emergency medical care of the child. I agree to pay all costs associated with such medical treatment and related transportation for the child. I agree that the child has health insurance to pay any medical bills incurred for personal injuries at the Third Grade Book Club, Creative Writing Club, and Drama Club and waive any right of subrogation against Jordan Kurth. To the fullest extent allowed by the law, I agree to pay all uninsured medical expenses incurred by the child as a result of their participation in our clubs. 3. Release/Indemnity and Agreement Not to Sue. To the fullest extent allowed by law, I agree to completely release, indemnify, and hold Jordan Kurth from all claims, losses, and damages. I agree to never file a lawsuit against Jordan Kurth. 4. Responsibility. I shall have the sole responsibility to educate myself and the child concerning the risks of any activity. I shall reiterate all rules and instructions to my child. I shall make all decisions concerning the child's participation in the activity and shall enforce all rules and instructions. I represent and warrant that the child is physically, mentally, and emotionally able to participate in all of the activities and follow the rules/instruction. I agree to be fully responsible and to pay for any damage or loss. 5. Payment. I agree to make all payments every month by the Friday before our first meeting of the month. The full amount for each club will be paid once before Friday of the first meeting. I acknowledge that any payment received after this date will result in a late fee of $20. Additional late payments of $10 will be applied per week until full payment is made. Full payment must be made before attending any club or participation is not allowed. Payment is non-refundable. I have carefully read, clearly understand, and voluntarily sign this authorization, payment agreement, and indemnification agreement and release from liability. *
