Registration Deadline: Sunday, March 24th
Please complete the electronic registration below for each child that will be attending. *Space is limited for children 28 months and younger*
Please read the waiver below. To agree, please select “Yes”.
ASSUMPTION OF RISK, GENERAL RELEASE FOR ATHLETIC, PHYSICAL EDUCATION, EXTRACURRICULAR PROGRAMS AND SUMMER PROGRAMS
MEDICAL AUTHORIZATION FORM
I, the undersigned parent(s) or legal guardian(s) (“Parent”) of the minor child identified below (“Child”), voluntarily and knowingly enter into this Assumption of Risk, General Release and Medical Authorization Form as a condition for Child’s participation in one or more of OHS’ Extracurricular and Summer Programs.
WHEREAS, although OHS is an outreach of First Presbyterian Church Nashville (“FPC”), the OHS school-sponsored Extracurricular and Summer Programs are not conducted by, associated with or affiliated with FPC or its Recreation Department and that FPC has no responsibility or liability for said OHS school-sponsored Extracurricular and Summer Programs; and,
WHEREAS, OHS organizes and conducts a variety of school-sponsored Extracurricular and Summer Programs (collectively, “Extracurricular and Summer Programs”); and,
WHEREAS, I desire for Child to participate in one or more of OHS’ Extracurricular and Summer Programs; and,
WHEREAS, participation in any Extracurricular and Summer Programs carries with it inherent risks of personal injury, including but not limited to, serious personal injury or death, and loss or damage to property; and,
WHEREAS, I am aware of such risks to Child and I have had adequate opportunity to discuss such risks with OHS officials and, notwithstanding such risks, I desire for Child to participate in one or more Extracurricular and Summer Programs; and,
WHEREAS, I knowingly and voluntarily execute this Assumption of Risk, General Release and Medical Authorization Form for the purposes herein contained with the understanding and intention to be legally bound by its terms and conditions.
NOW, THEREFORE, for and on behalf of myself and Child (for whom I am legally responsible), I agree as follows:
The foregoing recitals are incorporated herein by reference.
I hereby release, discharge, covenant not to sue and covenant to hold harmless OHS and FPC, and their respective trustees, officers, faculty, staff, including coaches, representatives and agents (collectively, “Releasees”), jointly and severally, from and against any and all actions, causes of action, claims, demands, damages, costs, loss of services, expenses and compensation, on account of, or in any way arising out any personal injury or property damage, caused for any reason, including the negligent acts or omissions of Releasees, but not including their gross negligence or willful misconduct, that I, my heirs, executors, administrators or assigns may now have or hereafter have as a parent or legal guardian of Child, together with all actions, causes of action, claims, damages or demands that Child has or may have hereafter, either before or after Child reaches the age of majority, arising out of or related to Child’s participation in one or more of the Extracurricular Programs and Summer Programs.
In the event that Child becomes ill or is injured while participating in an Extracurricular Program or Summer Program, I hereby authorize and give permission to any trustee, officer, employee, agent or representative of OHS to seek and obtain any emergency medical treatment for Child and I further authorize any physician or health care professional to render treatment to and for Child, and I agree to be financially responsible for any and all such treatment and care.
I further state that I have carefully read and understand the foregoing Assumption of Risk, General Release and Medical Authorization Form that I have had adequate opportunity to ask any questions regarding the Extracurricular Program(s) in which Child will be participating, and that I sign this Assumption of Risk, General Release and Medical Authorization Form voluntarily, this _____ day of __________________, 2016.
Please type your name above to verify that you have read and agree to the liability waiver.
Please list the age of your child. If your child is younger than 3 years old, please list the age in months.
Please list the current grade level of your child. If the student is younger than Pre-K, list N/A.