Lake George Teen Center Waiver 
The waiver below is to be completed by parents/guardians AND teens who plan to attend the Lake George Teen Center. 
Sign in to Google to save your progress. Learn more
Email *
Name of teen center participant *
Parent(s) Names and/or Legal guardian(s) of participant *
Home Address *
Please list all emergency contact information. Name, relation to teen, and phone number(s) *
Date of birth *
MM
/
DD
/
YYYY
Academic grade *
Please read all following information: *
It is my understanding that participating in the programs/recreational and other activities of LakeGeorge Teen Center is a privilege. I will not be able to participate in Teen Center activities if I did not participate in school on a given day. Prior to my participation, I acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity related accidents, physical injury due to transportation related accidents, illness, or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware. I understand that the child named above may be participating in events at the Lake George Senior/Community Center, Hillview Library, Caldwell Library, and other locations (To be determined) during the school year.
Release of Liability: *
Release of Liability: by signing this Permission/Waiver Form, I expressly warrant that the child named above is capable of with standing both the physical and mental demands of the activities he/she will be participating in. I also expressly assume all risks of the child participating in the activities, whether such risks are known or unknown to me at this time. I further release LakeGeorge Teen Center and its leaders, employees, volunteers, and agents and associated organizations/entities from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. I further agree to indemnify and hold harmless Lake George Teen Center and its leaders, employees (Director and Assistant Director), volunteers, or agents and associated organizations/entities from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during such activities.
Medical Treatment *
Medical Treatment: I recognize that there may be occasions where the child named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of Lake George Teen Center to seek and secure any needed medical attention or treatment for the child named above, including hospitalization, if in the agent's opinion such need arises. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment.
Therapy Dog/Animal exposure *
Occasionally local therapy dogs and therapy dogs in training will visit teen center. Trainers and handlers will be present at all times with the dogs. Therapy dogs visiting with teens are intended to help create a calming and relaxing environment and to provide teens with the opportunity to interact with the animals if desired. Advance advertising of animal visits will be provided when possible. The teen center is not responsible for any interactions that your child chooses to have with visiting animals. Should you have any concerns or prefer your child not interact with visiting animals you are required as the parent/guardian to notify the Director. 
Required
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report