Waiver and Release by Parent of Minor Child

Waiver and Release by Parent of Minor Child from Liability for Participation in Rock Wall Climbing Session at School

The undersigned (Name of Parent or Guardian)

of (street address, city, state, zip code),

on behalf of my child, (Name of child participating),

(hereinafter referred to as Child), do/does hereby waive and release, indemnify, hold harmless and forever discharge the State of (Name) and (Name) School District, whose principal office is located at (street address, city, state, zip code), including their agents, employees, officers, directors, affiliates, volunteers, successors and assigns, (State and School District being hereinafter jointly and severely called District), of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I or Child ever had or may have, arising from or in any way related to Child’s participation in any rock climbing wall activity on (date) at (location).

This waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct of District, which includes its agents, employees, officers, directors, affiliates, successors and assigns are hereby jointly and severally referred to herein as Released Parties. This waiver and release includes (but is not limited to) any injuries to Child resulting from Child’s participation in any rock climbing wall activity or physical activities conducted by Released Parties.

I understand that the activities that Child will participate in, even though closely supervised, can be dangerous and may cause serious or grievous injuries, including bodily injury and/or death. On behalf of myself, Child, my heirs, assigns and next of kin, I and said Child waive all claims for damages, injuries and death sustained by me or said Child which we may now or hereafter have against Released Parties regarding any such activity.

I certify and warrant that my Child is in excellent health, has the necessary and requisite skills to participate in all facets of the rock climbing and to participate in all activities requested by Released Parties except as specifically noted below. The nature of the activities has been fully disclosed to me and Child and any flyer, advertisement, or brochure relating to the participating activities is expressly made a part of this Waiver and Release.

By this Waiver and Release, I, on behalf of said Child, assume any risk, and take full responsibility for any claims of personal injury or death associated with the rock wall climbing activities described above and conducted by Released Parties.

This Waiver and Release contains the entire agreement between the parties, and supersedes any prior written or oral agreements concerning the subject matter of this Waiver and Release. The provisions of this document may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties.

I have read, understand and fully agree to the terms of this Waiver and Release. I understand and confirm that by signing this Waiver and Release said Child and I may have given up considerable future legal rights. I have signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. Initials of Parent/Guardian

My signature is proof of my intention to execute a complete and unconditional Waiver and Release of all liability to the full extent of the law.

Medical Conditions

Child is subject to the following allergies or medical conditions, and I authorize Released Parties to disclose these conditions to a physician or other medical professional in the event said Child should require emergency medical care:

Prohibited Activities

As a result of the above-mentioned medical conditions, I, on behalf of Child, am prohibiting involvements in the following specific activities:

WITNESS my signature on the day of , 20 .