Special Summer Vacation 2009 Hours: (June 10 - June 21)
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PARENTAL PERMISSION AND MEDICAL CONSENT WITH LIABILITY RELEASE By submitting the signup form for FiredWorks Summer Lesson Sessions, we, being the lawful parent(s) and/or guardian(s) of the child/children listed (the "Child/children"), hereby consent to the participation by the Child/Children in ceramic painting activities(the "Activity") conducted by Clayworks of Highland Park ("FiredWorks") and to the participation of the Child/Children in all events relating to the activity on the dates submitted. We hereby further authorize(s) any of the staff, employees, agents and representatives of FiredWorks to provide for, approve and authorize any health care at any hospital, emergency room, doctor's office or other institution; employ any physicians, dentists, nurses, or other person whose services may be needed for such health care; review and if necessary disclose the contents of any medical records; execute any consent form required by medical. dental or other health authorities incident to the provision of medical, surgical or dental care to the Child/Children. Health care shall include but not be limited to the administration of anesthesia, X-ray examination, performance of operations, diagnostic and other procedures. If there is no medical emergency, the guardian will first use reasonable efforts to contact the parent(s) and/or guardian(s) before administering or authorizing any treatment. Notwithstanding other provisions in this Consent Form, FiredWorks shall not have the authority to withhold or withdraw life-sustaining procedures for the Child/Children. We, the parents, assume(s) all risk of injury or harm to the Child/Children associated with participation in the Activity and agree(s) to releases, indemnify, defend and forever discharge the FiredWorks and its staff, employees and agents (collectively "FiredWorks") of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action (collectively the "Claims") in respect of death, injury, loss or damage to the Child/Children or by the Child/Children, howsoever caused, arising or to arise by reason of or during the Child/Children's participation in the Activity. This Consent Form may be revoked at any time with written notice to FiredWorks. |