I, Parent/Legal Guardian * parent or legal guardian of Student Name* a minor child, hereby give permission for my child to participate in the activities specified below. Each time my child participates in a new activity, I will write and specify the vendor name.
I certify that my child is physically, mentally and emotionally able to participate in the Activities in which s/he chooses to participate. In consideration of being permitted to participate in the Activities, I hereby voluntarily release Heartland Charter School from any and all liability resulting from or arising out of my child's participation. I understand and agree that I am releasing not only the entities set forth above, but also the officers, agents, and employees of those entities. I understand and agree that this Waiver/Release will have the effect of releasing, discharging, waiving, and forever relinquishing any and all actions or causes of action that I, or my child, may have or have had, whether past, present or future, whether known or unknown, and whether anticipated or unanticipated by me or my child, arising out of participation in the Activities.
I understand and agree that by signing this Parental Authorization and Waiver/Release of Liability, I am assuming full responsibility for any and all risk of death or personal injury or property damage suffered by me and/or my minor child while participating in any and all chosen activities sanctioned by Heartland Charter School and its affiliates. I understand and agree that by signing this Parental Authorization and Waiver/Release of Liability, I am agreeing to release, indemnify, and hold harmless Heartland Charter School and their directors, officers, agents,, and employees from any and all liability or costs, including attorney fees, associated with or arising from participation in the Activities. I understand that this Waiver/Release of Liability will be binding on me, my spouse, my heirs, my personal representatives, my assigns, my children, and any guardian ad litem for said children.
I acknowledge that I have read this Parental Authorization and Waiver/Release ofLiability and that I understand the words and language in it. I also understand that this Parental Authorization and Waiver/Release ofLiability is valid for the duration oftime that my child participates in the current school year.
COVID-19 RISKS: I understand that it is my responsibility to ensure that the business providing the enrichment services identified above is following all local, state and federal health guidelines required in order for the business to provide said services. I understand that my child(ren)’s participation with in-person services during a health pandemic may result in my child contracting COVID-19, which may be spread to me and my family, which may result in severe illness, hospitalization and/or death. By signing hereon, parent/guardian waives liability against and holds harmless the school and its board members, staff, volunteers, vendors, agents, the school district, and the State of California relating to the contraction of COVID-19 to the student or his/her family. If the student/parent/guardian believes that an unsafe condition or circumstance exists with respect to the activity(ies), student will discontinue participation and immediately notify school staff. Student shall not further participate until the unsafe circumstance is remedied.
I acknowledge that I have read this Parental Authorization and Waiver/Release of Liability and that I understand the words and language in it. I also understand that this parental Authorization and Waiver/Release of Liability is valid for the duration of time that my child participates in the current school year.
Student Full Name Student Name Grade Grade*