JUMPSTART LEARNING CAMP

Release & Liability Waiver

Release of Photographs

                For valuable consideration, the undersigned understands and agrees that photographs may be taken during recreation programs and the undersigned hereby gives permission to have his/her photo taken and authorizes the use and reproduction of said photos by the JUMPSTART LEARNING CAMP.  All negatives and prints shall become the sole property of the JUMPSTART LEARNING CAMP.

_____________________________              _______________________  ____________

  Print Name of Student                                     Signature                                 Date

If student(s) is under the age of 18, his/her legal guardian hereby authorizes the use of the photos as stated above.

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 Signature of Parent or Guardian                       Relationship                           Date

Liability Waiver/Medical Treatment Consent

(In order for us to process your enrollment(s), you must sign the Liability Waiver/Medical Treatment Consent after you have read and agreed to the terms.  Enrollments where the waiver/consent has been altered will not be processed).

In consideration for my and/or any of my family members’ participation in the JUMPSTART LEARNING CAMP program(s) that I wish to register for, I voluntarily RELEASE the JUMPSTART LEARNING CAMP, JUMPSTART LEARNING CAMP FINANCE AUTHORITY AND THEIR OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS (hereinafter referred to as “RELEASEES”) from any and all liability for injuries or death or property damage to me and/or my family members resulting from, arising out of, or in any way connected with my and/or any of my family members’ participation in the JUMPSTARTS LEARNING CAMP’s program(s) or use of the JUMPSTART LEARNING CAMP’s facilities in connection with this/these program(s).  I understand that this WAIVER and RELEASE is applicable even though the negligent activities of the RELEASEES may have contributed to the injury or death or property damage suffered by me or any of my family members participating in this/these program(s).  I further agree to INDEMNIFY and HOLD HARMLESS the RELEASEES from and against any and all liability, claims, causes of action, and/or losses of any nature or kind (including litigation-related expenses such as attorney and expert witness fees) resulting from participation in this/these program(s) whether caused by any negligent act or omission of the RELEASEES.

                I further understand that serious accidents may occur in the JUMPSTART LEARNING CAMP’S program(s) that I am enrolling for, those participants in this/these program(s) may sustain mortal or serious personal injuries, and/or property damage, as a consequence of their participation in this/these program(s).  Knowing the risks of said event, nevertheless, I HEREBY AGREE TO ASSUME THOSE RISKS AND TO RELEASE AND HOLD HARMLESS TO THE FULLEST EXTENT ALLOWED BY LAW ALL OF THOSE PERSONS MENTIONED ABOVE WHO THROUGH PASSIVE OR ACTIVE NEGLIGENCE OR CARELESSNESS MIGHT OTHERWISE BE LIABLE TO ME FOR DAMAGES.

                It is further understood and agreed that this waiver, release, hold harmless and indemnification agreement is to be binding on me, any of my participating family members, and al of our heirs, representatives, and assigns.

                I hereby authorize qualified physicians to render medical treatment or care that they may deem necessary for me or my family members in case of illness or accident during such program(s).  In the event of injury and if a parent cannot be reached, local fire/paramedic authority will be contacted to transport the injured to o Novato Community Hospital,  o Marin General Hospital, or o Kaiser Permanente.  (Please check one.  If none are checked, the injured will automatically be transported to closest hospital facility). 

By my signature below, I signify that I have read, understand, and voluntarily agree to be bound by each of the terms stated above.

Signature_________________________________________               Date_____________________________