I understand that the above-named activity, sponsored by the SCVYO Foundation, involves physical activity, and that accidents can occur during the above-named activity, and that participants in this or any physical activity can suffer serious injury or death. I further understand that while SCVYO Staff and the SCVYO Foundation Volunteer Leaders may be trained in basic first aid and CPR, they are not medical professionals and are not trained to diagnose, monitor or treat chronic or acute medical conditions, whether preexisting or caused by participation in the above-named activity. Nevertheless, I, AS THE PARENT/LEGAL GUARDIAN, OF THE ABOVE-MENTIONED MINOR (hereafter “Minor”) AND FOR MYSELF, HEREBY ASSUME THESE RISKS OF PARTICIPATING IN THE ABOVE-MENTIONED SPECIAL EVENT. In return for allowing Minor to participate, I, on behalf of Minor and for myself, hereby waive, release, and discharge any and all claims for damages for personal injury, disability, death, or property damage of any kind which may hereafter accrue to Minor or myself as a result of his/her participation in this activity. This release is expressly intended to discharge in advance the SCVYO Foundation and its employees, agents, and volunteers from and against any and all liability arising out of or connected in any way with Minor’s participation in this activity. THIS WAIVER AND RELEASE WILL APPLY EVEN THOUGH LIABILITY MAY ARISE OUT OF NEGLIGENCE OR CARELESSNESS ON THE PART OF THOSE DISCHARGED INCLUDING THEIR EMPLOYEES, AGENTS, AND VOLUNTEERS, AND INCLUDING GROSS NEGLIGENCE TO THE EXTENT THAT CALIFORNIA LAW PERMITS SUCH WAIVER AND RELEASE. This Waiver and Liability Release shall apply to Minor and myself, as well as any of our heirs, executors, or administrators. I hereby certify that I am the parent or legal guardian of Minor and that I am acting in that capacity. Further, I acknowledge that I have read this document and understand its contents. For the Parent/Guardian: By submission of this waiver of liability, I acknowledge that the SCVYO Foundation sponsors the above-named activity and realize that NO MEDICAL INSURANCE IS PROVIDED. I, the parent/guardian of the above named Minor, hereby approve his/her participation in the above-mentioned activity. Further, I consent to emergency medical treatment for this minor should the need arise. I expect that the activity supervisors will make an effort to contact me, time permitting, before any treatment other than minor first aid, is administered. PHOTO RELEASE: I hereby grant permission to the employees of the SCVYO Foundation to include pictures and/or video of my child taken during organization activities, in any future brochures or other publicity developed by the SCVYO Foundation or by the media. I understand that the SCVYO Foundation owns the images and videos and I will not receive compensation for the use of the images.
Parent Name *
Parent Name
Student Name
Student Name
Student Date of Birth *
Student Date of Birth
Please check the box to acknowledge your consent as the parent/gaurdian of the referenced child.
Today's Date
Today's Date