Terms and Conditions, Medical Consent: The following must be read and agreed at registration, before your registration will be accepted and prior to your child’s participation in their Avon After School program(s).
I /We affirm that I am/We are the parent(s) or the Legal Guardian(s) of this applicant and have the requisite authority and right to execute this waiver and consent form without any other person or third party’s additional consent or approval.
I/We acknowledge that Darien After School, dba Avon After School, LLC (the “Company”) is a separate entity from Avon Public Schools.
I/We hereby give permission for my/our child to participate in an after school program run by the Company (the “Program”) during the 2019-2020 school year during “Program Hours” including but not limited to, one hour before school starts and/ or one hour after school dismissal. I/we understand and acknowledge that the Company is fully responsible for all aspects of the Program, and that the Company will be providing care and supervision of all of the students in the Program, including my/our child, during Program Hours.
I/We understand that the Company does not provide any accident or health insurance for participants in the Program and that it is my/our responsibility to provide such coverage.
I/We understand that the Company is not responsible for any personal property lost, damages or stolen while my/our child is participating in the Program.
I/We have read the Parent’s Corner and the terms and conditions of participation in Avon After School programs and agree to abide by the rules and guidelines set forth therein.
I/We acknowledge and affirm that the Avon Board of Education and the Town of Avon are not responsible for any aspect of the Program, including without limitation, the care and supervision of the participants in the Program during Program Hours, and I/we agree to release and hold harmless the Avon Board of Education and the Town of Ridgefield, their members, agents, officers, employees, representatives and volunteers, from any and all liability, claims, suits, demands, judgments, costs, interest and expense (including attorneys’ fees and costs) for any loss, damage or injury, including that caused by negligence, that may occur during the Program.
I/We certify that to the best of our knowledge my/our child is physically able to participate in all parts of the Program. I/We understand that I/we will be notified in the case of a medical emergency. I/We acknowledge that because the Company is a separate entity from my/our child’s regular school, the Company does not have access to information or medications stored in my/our child’s school’s health office, even if the Program is held on the site of my/our child’s regular school. I/We further acknowledge that if my/our child has any allergies or other conditions that require medication or special treatment, I/we have disclosed such conditions to the Company on the Allergy and Other Conditions Disclosure and Waiver Form at Registration for participation in such Program. We acknowledge that it is my/our responsibility to ensure that the Company has a supply of any needed medication for the Program’s sole use during the Program hours, and that if a reaction or medical issue is detected, 911 emergency protocols will be activated, and that under such circumstances, there is a possibility that emergency personnel or other Good Samaritan may administer epinephrine or other medication and that there is a possibility of a life-threatening situation developing thereby in the event of illness or injury to my/our child, and I/we am unable to be so contacted, then in the case of sickness or accident, I/we hereby give my/our permission to the Company employees, contractors and/or medical personnel selected by the Company to give necessary first aid/CPR to my/our child and to otherwise order or preform any medical attention deemed necessary and authorize the person in charge to obtain and consent to, on my/our behalf, whatever medical treatment, emergency transportation, and hospital care is deemed necessary or advisable by such persons for the wellbeing of my/our child. I understand that the Company is not responsible for any medical expenses incurred during an emergency and accept financial responsibility for all such medical treatment given my/our child.
I/We, on behalf of ourselves, our family, heirs, personal representative(s), and/or assigns, acknowledge and agree that my/our child’s participation in the Program may result in minor injuries, major injuries or serious injuries, including permanent disability and death, and severe social and economic losses which might result not only from my/our child’s own actions, inactions, or negligence, but the actions, inactions or negligence of others, the rules of play, or the conditions of the premises or of any equipment used, and that safety rules and regulations do not prevent all injuries.
I/We do hereby, on behalf of ourselves, our family, heirs, personal representative(s) and/or assigns, waive, release, absolve, indemnify, and agree to hold harmless the Company, its members, employees, agents, the organizers, sponsors, supervisors, and participants for any claim arising out of any injury to or illness of my/our child, whether the result of negligence, the following of 911 emergency protocols or for any cause. I/We understand that I/we are releasing claims and giving up substantial rights, including my/our right to sue, and are doing so voluntarily.
Contact: firstname.lastname@example.org / 888.212.3837