Signature
PLEASE READ: I hereby give permission to the medical personnel to secure proper treatment and hospitalization for my child if I CANNOT be reached at the time of the emergency.
I consent to my child’s participation in all activities and trips that are part of the Teen Program and under the direction of COA staff. I permit COA to transport my child as necessary.
I give permission to COA to use photographs/video of my child in publicizing and promoting the agency’s work.
I understand that the camp participates in the USDA federal food program and that COA complies with USDA policy, which prohibits discrimination because of race, color, sex, age, handicap, or national origin.
I grant permission to COA to use participants’ demographic information record to evaluate overall impact of the program to obtain continued funding for the program.
LIABILITY WAIVER: I/we recognize that unanticipated situations and problems can arise during COA Youth & Family Centers activities that are not reasonably within the control of the COA Youth & Family Centers staff (including volunteers).
I/we therefore agree to release and hold harmless the COA Youth & Family Centers Directors, its agents, officers, employees, and volunteers, from any and all liability, claims, suits, demands, judgments, costs, interest and expense (including attorneys’ fees and costs) arising from such activities, including any accident or injury to myself or my child and the costs of medical services.