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, LLC (the “Company”) is a separate entity from Darien 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 2018-2019 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 understand and acknowledge further that the Darien Board of Education and the Town of Darien are not responsible for any aspect of the Program, including without limitation the care and supervision of participants in the Program during Program Hours.
I/We acknowledge and affirm that the Darien Board of Education and the Town of Darien 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 Town of Darien and the Darien Board of Education, 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. If my/our child has any allergies or other conditions, I/we have disclosed such conditions to the Company on their Allergy and Other Conditions Disclosure and Waiver Form. 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 my/our child, whether the result of negligence 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.