Parental Consent And Release Of Liability Agreement

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Parental Consent and Release of Liability Agreement
As the parent or legal guardian of _________________________ (camper’s name please print), I give
my consent for him/her to participate in the camp program conducted by Champions Swim and Travel
Experience. I understand that participation in this camp and related activities involves certain risks, and
may result in unavoidable injuries. These injuries may include muscle strains and tears, broken bones, and
severe injuries including, but not limited to, permanent paralysis, or even death. I am fully aware of the
risks and possibility of injury involved and acknowledge that I am assuming the risk of such injury by my
child’s participation in the camp.
I further acknowledge that I agree to provide health insurance for my minor child and will be responsible
for any and all medical and related bills that may be incurred by me for any illness or injury that my child
may sustain during the camp and while traveling to and from the site for the camp.
I further acknowledge and authorize the staff of Champions Swim and Travel Experience to act according
to their best judgment in any situation requiring medical attention, whether an emergency or not, until
such time as I am contacted to make decisions concerning my child’s treatment. If in the judgment of a
physician or designee it is necessary for health care reasons to proceed with treatment without delay, this
treatment may proceed without prior notification of the undersigned, although every attempt will be made
to notify me in the event of such an injury or illness. I agree that any medical information provided to this
camp shall be released to other health care providers who may be providing care.
Knowing these facts and in consideration of my child’s participation in the camp, I, acting as parent or
legal guardian, agree to release and hold harmless the respective officers, directors, representatives,
members, agents, employees, or coaches of Champions Swim and Travel Experience, from any and all
liability for negligence or any other claim, demand, action, judgment, loss, liability, cost and expenses
(including without limitation, attorney’s fees and costs) arising out of or in connection with the camp,
including any claim arising out of or in connection with, whether directly or indirectly, any illness, injury,
damage or loss to person or property that my child may incur or sustain during the camp, all activities
associated with the camp, and while traveling to and from the site for the camp.
I acknowledge that I have read this Release and Waiver of Liability in its entirety and fully understand its
contents. I am aware that this Release contains an acknowledgement of my voluntary and knowing
assumption of the risk of illness or injury. I further acknowledge that I have signed this document
voluntarily and of my own free will.
____________________________________
________________________________
Parent/Guardian Signature
Date
Address: _____________________________________________________________________________
Parent/Guardian Home Phone: ______________________ Cell Phone: ___________________________

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