Clark Area Rec Center Waiver

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Liability Waiver

The undersigned parent/legal guardian hereby gives permission to the Clark Area Rec Center for my child(ren) ______________________ (please insert child's /children's full names below) to take part in the Clark Area Rec Center Activites. *

Should my child require immediate or emergency medical care while engaged in an activity sponsored by the Clark Area Rec Center, in my absence, I hereby grant the Clark Area Rec Center authority to release my child for medical treatment to such medical personal at the Clark Area Rec Center determines appropriate under the circumstances. *

I Agree

Required

In consideration for the privilege of allowing my child to participate in the activities provided by the Clark Area Rec Center, I agree to release and hold harmless the Clark Area Rec Center and its volunteers, from any liability to or responsibility for bodily injury, damage or illness to the above-identified child while participating in any youth athletic or social activity which will be held in the Clark Area Rec Center. Further, I agree to indemnity and hold harmless Clark Area Rec Center and its volunteers with respect to any claim asserted by or on behalf of my child as a result of bodily injury, illness or damage. *

I Agree

Required

List Any Allergies Your Child Has:

PLEASE READ CAREFULLY, THIS PERMISSION SLIP IS A LEGAL DOCUMENT WHICH INCLUDES A RELEASE OF LIABILITIY AND INDEMNIFICATION. By typing your name below you agree to these terms and conditions: *

Your Telephone Number: *

Emergency Contact Name *

Emergency Contact Number *

Any other special instructions or medical conditions we need to know about in regards to your child:

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