2018-2019


BAMBINI DA ISCRIVERE
Figlio #1
Data di nascita

DATI DEI GENITORI
Genitore #1
Genitore #2
Indirizzo

ACCIDENT WAIVER AND RELEASE OF LIABILITY

Functions and Activities
I acknowledge that participation to the Scuola Piccoli Italiani di Boston, Inc. (ScuolaPIB) activities may pose some risk of personal injury and that I undertake and assume this risk for myself and my child. On behalf of myself and my child, I further waive and release the promoters of the activity, school facility, any insuring entity of the above, and their directors, board members, officers, employees, volunteers, agents, representatives, or assigns, as well as the activity sponsors, from any and all liability, including, but not limited to, liability arising from negligence or fault of the entities or persons for any injury or disability which may occur as a result of my or my child’s participation in the above activity. I am assuming all risks on behalf of myself and my child that may arise from negligence or carelessness on the part of any of the persons or entities being released, as well as from defective equipment, real property or personal property that is owned, maintained or controlled by the above persons.

Release of Liability

I certify that my child and myself are physically fit and sufficiently prepared for participation in the activity and that there are no health related reasons or problems which would preclude the participation of myself or my child in the activity. I have not been advised of any reason which would limit my child or myself in participating in the activity. I shall defend, hold harmless, and indemnify the parties from and against all losses, claims, damages, costs or expenses (including reasonable legal fees, or similar costs) in connection with any action or claim brought or made (or threatened to be brought or made), for, or on account of any injuries or damages, received or sustained by myself and/or my child arising during the course of the activity.

Photography
I authorize Scuola PIB to include myself/child in pictures for promotional purposes of events he/she is participating in.  I understand that my child’s full name will not be published with the pictures he/she are in.

First Aid and Emergency Medical Treatment
I consent to receive any medical treatment deemed advisable for an injury to myself or my child during the activity and that any medical or other insurance for myself and/or my child will be insurance of first resort before contribution by any other insurance for any other person or entity, including accidental death and dismemberment insurance and accident medical insurance.

Communication to class
I authorize Scuola PIB to share my name, my home address, and my email address with parents of children attending the same class as my child / children.

By signing this Waiver, I assume all risk of my child and/or myself attending the Scuola PIB.
This Agreement constitutes the sole and only agreement between the parties concerning my child’s and my release and indemnification as a condition for participating in this activity.

I certify that I have read this document, and I fully understand its contents. I am aware that this is a release and indemnification of liability for myself and my child, and I sign it of my own free will.

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