The Jule Foundation Teen Enrichment Program - PDF document

1 The Jule Foundation Teen Enrichment Prog
The Jule Foundation Teen Enrichment Program General Program Registration & Waiver Form Student Name: ________________________________________________ Grade: _________________ Address:______________________________________________________________________________ Street City State Zip Co de Home Phone Number: _______________________________ Mother’s Name: ___________________________ Phone Number: ________________________ Father’s Name: __________________________ Phone Number: ________________________ Emergency Contac t Name: ______________________________________________________ Best Contact Phone: __________________________________________________________________ Please indicate if your child will need Transportation: ________ Yes _______ No Please list any allergies or medical conditions that The Jule Foundation Teen Enrichment Program should be aware of: ______________________________________________________________________________ __________________________________________________________ ____________________ ______________________________________________________________________________ Liability Waiver : I understand that participation in the program and other voluntary activit i es inc ludes risk of injury. Although serious injuries are

2 not common in supervised programs as th
not common in supervised programs as this , it is impossible to eliminate the risk. I/we understand that my child’s participation in The Jule Foundation Teen Enrichment program is voluntary and that my child and I/we are free t o choose not to participate. I/we consent to my child’s participation in any of the approved program activities . I understand that The Jule Foundation Teen Enrichment Program, their employees, officers and agents will not be liable for personal injuries an d/or property damage as a result of my child’s participation in such programs or activities. I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify The Jule Foundation Teen Enrichment Program , their employees, officers and agents, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in The Jule Foundation Teen Enrichment Progra m . I/We give permission for our son/daught er to participate in all program activities, and do forever release The Jule Foundation and its teachers, staff, volunteers and agents from any and all actions, all known and unknown personal injuries or property d amage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire. The Jule Foundation Teen Enrichment Program By signing this Agreement, I/we acknowledge that we have read and understand this document and accept the risk and responsibility of participation in the teen enrichment program. Parent’s Signature: _______________________________________ _ Date :______________