I, THE UNDERSIGNED PARENT
AND/OR GUARDIAN OF ____________________________, ALLOW MY CHILD TO PARTICIPATE
IN THE ACTIVITIES OF TS&DC, INCLUDING BUT NOT LIMITED TO ON CAMPUS EVENTS AND
SCHEDULED OFF CAMPUS EVENTS. I DO
HEREBY RELEASE AND DISCHARGE TS&DC FROM ANY AND ALL DAMAGES ON ACCOUNT OF
ANY INJURIES OR ILLNESSES SUSTAINED TO OR BY MY CHILD WHILE ENGAGED IN SUCH
ACTIVITY AT TS&DC, WHETHER RELATED OR NOT TO THE ACTIVITY ENUMERATED ABOVE.
I UNDERSTAND THE RISK OF INJURY MAY BE SIMILAR SPORT TYPES OF INJURIES
LIKE HEAT EXHAUSTION, FALL, PEDESTRIAN ACCIDENTS, OR EVEN DEATH.
THIS AGREEMENT SHALL
CONSTITUTE A BAR OF ANY RECOVERY BY THE UNDERSIGNED INDIVIDUALLY OR BROUGHT FOR
AND ON BEHALF OF THE CHILD AND SAID AGREEMENT MAY BE URGED AND USED BY TS&DC
AS A BAR TO THE ANY RECOVERY BY THE UNDERSIGNED OR BY THE CHILD IN ANY SUIT OR
CLAIM INSTITUTED ON ACCOUNT OF ANY INJURY OR ILLNESS SUSTAINED BY MY CHILD WHILE
ENGAGED IN THE ACTIVITIES OF TS&DC.
HOLD
HARMLESS AND INDEMNIFICATION AGREEMENT
I, THE UNDERSIGNED, RELEASE
AND DISCHARGE TS&DC REPRESENTATIVES FROM ANY AND ALL LIABILITY FROM ANY AND
ALL CLAIMS OR DAMAGES FROM ANY ACCIDENT OR ILLNESS SUSTAINED TO OR BY MY CHILD
WHILE ENGAGED IN THE ACTIVITIES OF TS&DC.
I AGREE TO HOLD HARMLESS AND INDEMNIFY TS&DC AGAINST ANY LOSS,
DAMAGES, OR COST WHATSOEVER NATURE INCLUDING EXPENDITURE OF ATTORNEYS FEE WHICH
MAY BE SUFFERED AS A RESULT OF ANY ACTION, CLAIM, OR DEMAND BY MY CHILD OR MY
CHILDS HEIRS, BY ME, MY HEIRS, SUCCESSORS, OR ASSIGNS, OR BY ANY OTHER PERSON
ON HIS/HER BEHALF OR FOR THE BENEFIT OF THE CHILD.
I ALSO AGREE TO REIMBURSE TS&DC FOR ANY AND ALL EXPENSES INCURRED
FROM THE RETURN TRANSPORTATION OF MY CHILD FOR DISCIPLINARY REASONS.
MEDICAL
RELEASE AND INDEMNITY AGREEMENT
I,___________________________________________, PARENT OR GUARDIAN OF ________________________________________, HEREBY ACKNOWLEDGE THAT
AS PART OF THE ACTIVITIES OF MY CHILD______________________________________,
ATTENDING TS&DC, THAT THERE IS THE POSSIBILITY MY CHILD MAY NEED TO RECEIVE
MEDICAL ATTENTION DUE TO INJURY OR ACCIDENT.
I UNDERSTAND THAT TS&DC OR ITS REPRESENTATIVES WILL MAKE A REASONABLE
EFFORT TO CONTACT ME IN THE EVENT OF INJURY OR ACCIDENT TO MY CHILD BASED ON THE
CIRCUMSTANCES IN THE EVENT THAT TS&DC OR THE REPRESENTATIVES ARE NOT ABLE TO
CONTACT ME, OR IF THE NEED FOR MEDICAL CARE APPEARS TO BE IMMEDIATE, THEN I
INSTRUCT AND AUTHORIZE TS&DC AND THEIR REPRESENTATIVES FROM ANY LIABILITY
FOR THEIR EFFORTS TO SECURE REASONABLE AND NECESSARY MEDICAL TREATMENT FOR MY
CHILD AS STATED ABOVE.
I,THE UNDERSIGNED PARENT OR
LEGAL GUARDIAN SHALL ASSUME FULL RESPONSIBILITY FOR ALL MEDICAL BILLS,
INCLUDING DOCTOR AND/OR HOSPITAL BILLS INCURRED BY MY CHILD THAT ARE NOT COVERED
BY THE TS&DC SUMMER CAMP ACCIDENT POLICY.
I FURTHER AGREE TO REIMBURSE TS&DC AND THEIR REPRESENTATIVES WHO MAY
INCUR EXPENSES IN THE TREATMENT OF AN ACCIDENT OR ILLNESS OF MY CHILD.
BY SIGNING THESE AGREEMENTS,
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THIS DOCUMENT AND DO HEREBY AGREE
TO ITS TERMS AND CONDITIONS
___________________________________________
SIGNED PARENT (LEGAL
GUARDIAN) DATE
_________________________________________
____________________
PRINTED NAME OF PARENT OR
GUARDIAN
PHONE NUMBER
WITH FEW EXCEPTIONS, STATE
LAW GIVES YOU THE RIGHT TO THE REQUEST, RECEIVE, REVIEW, AND CORRECT INFORMATION
ABOUT YOURSELF COLLECTED ON THIS FORM.
***PLEASE
INCLUDE A COPY OF YOUR INSURANCE CARD***
Student ________________
DOES THIS STUDENT HAVE AN
ALLERGY TO ANY MEDICATIONS? _________________________________
IS THE STUDENT ON ANY CURRENT
MEDICATION?___________________________________
DATE OF LAST TETANUS SHOT IS:
____________________________
NAMES AND TELEPHONE NUMBERS
FOR EMERGENCY CONTACT: ____________________________________________
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