Permission to Secure Treatment: In the event of any emergency, I authorize the Organization Directors to secure from any licensed hospital, physician and or medical personnel any treatment deemed necessary for my child’s immediate care and agree that I will be responsible for payment of any and all medical services rendered. I authorize the release of the medical information contained in this form. I understand that this authorization includes transporting my child by ambulance if necessary to the nearest medical treatment facility or hospital if I am unable to be reached first.

I recognize and acknowledge that there are certain risks of physical injury to participants and I agree to assume the full risk of any injuries, damages or loss regardless of severity which my son may sustain as a result of participating in any and all activities connected with the program. I agree to waive and relinquish all current and unknown future claims my son may have against the organization and its Directors, employees and volunteers as a result of participation in the program. I do hereby fully release and discharge the Organization and its Directors, employees and volunteers from any and all claims from injury, damage or loss arising from the activities of the program. I further agree to indemnify and defend the organization and its Directors, employees and volunteers against, and hold them harmless from, any and all claims resulting from injuries, damages, and losses sustained by my son arising out of, connected with, or in any way associated with the activities of the program.