The undersigned, as parent/legal guardian of the below mentioned child acknowledges that I have been directed to consult a physician regarding my child’s well-being, prior to my child starting any program or using any equipment of the Chicago Southwest Suburban Community Parish & Community Center Foundation (hereinafter called “The Center”). By consenting herewith to my child’s use of such equipment or participation in such program, I declare that I have consulted my physician regarding said child immediately beforehand, and I have advised said physician of my child’s participation in such program and possible use of the facilities and equipment of The Center.
Unless I communicate to The Center staff in writing, prior to said child’s participation in any program, or use of facilities, equipment or other assets, the presence of any physiological, behavioral, or disability problems of my child which could conceivably lead to injury or serious illness, I understand that The Center assumes no responsibility for any injury or adverse effect resulting from a lack of knowledge on the part of The Center staff of such condition.
Accordingly, and as a condition of said child’s attendance at The Center, the undersigned parent/legal guardian does hereby release and discharge The Center, its staff, employees, members and invitees from all claims of any kind or character which said child might have against The Center because of any injury which may be sustained while participating in any function of The Center or while on or off The Center premises which could have been reduced or prevented by communication of such child’s special needs or problem to The Center’s staff.
Further, the undersigned, as parent/legal guardian of the below mentioned child, acknowledges that any child’s use of the facilities, equipment, and other assets while attending functions of The Center, could involve physical activity which may result in exposure of the child to potential hazards and bodily injury including, but not limited to cuts, scrapes, slips and falls, water accidents, animal bites, insect bites and stings, insect-borne diseases, horseback accidents, highway crossings, carelessness and horseplay, unsportsmanlike conduct, poison ivy and allergic reactions.
While The Center attempts to reduce or avoid such hazards through instruction and safety procedures, parents/legal guardians understand that all risk of danger or injury cannot be precluded.
Understanding the Release Agreement as parent/legal guardian of the said child, I do hereby fully and forever release and discharge The Center, its directors, trustees, staff, employees, members, invitees and insurers from any and all claims, demands, damages, rights of action, or causes of action present or future, whether the same be known or unknown, anticipated or unanticipated resulting from or arising out of my said child’s use or intended use of said Center, its facilities, programs (whether on or off The Center premises) including transportation to or from such programs, and Center equipment and I agree to defend, indemnify and hold them harmless therefrom.
Caution, this is a release affecting you and your child’s legal rights. By signing this release, you hereby verify that you have read and understand its contents fully. If in doubt, consult your physician and/or attorney.
In the event of injury or mishap resulting in emergency hospitalization or other health care expenses being incurred, while subject child is a participant in any function of The Center or occurring to said child while on The Center premises, I, as parent/legal guardian, hereby agree that any insurance plan maintained by me or another, which insures said child for medical expenses, shall be the primary source of payment for such medical cost, and I further agree to do the necessary to process said claim and secure payment directly to the provider of such medical services.
The Center agrees to assume responsibility and pay or reimburse parent/legal guardian for the initial deductible amount, if any, which may apply to said injury and become the personal liability of parent/legal guardian. The Center does not assume any responsibility for additional medical expenditure other than as stated herein.
Your child’s participation in programs at The Center authorizes The Center to use photos or videos of your child for promotional services