Summer Program Registration Form

By signing below, and in consideration of my child being permitted to participate in the after school program, I understand and agree as follows:

Lauren's House provides no insurance coverage for participants, and I will be responsible for any and all medical treatment for my child including the cost thereof.

*I will inform the building administrator or designee of any reasonable accommodations my child needs in order for them to participate in after school activities. I understand that if the need for accommodations or medical diagnoses change, it is my responsibility to update the administrator/designee of those changes.

*In the event of a medical emergency, 911 will be called and every effort will be made to contact parent(s)/guardian(s); I will keep my phone records updated with Lauren's House. If my child has a chronic medical or health condition, I agree that calling 911 is an appropriate response if my child has a medical episode, and I have been informed of After-school Program staff members who have been trained to recognize my child’s symptoms and call 911 if necessary. I recognize that this type of intervention may be different than the health-related services provided during the school day in the after school setting.

*If my child has any allergy that could result in anaphylaxis (example: tree nut or bee allergy) I will provide an Epi-Pen to keep at the program site with a current prescription. If my child has asthma, I will provide an inhaler to keep at the program site with a current prescription. If my child self-carries their epi-pen or inhaler, I understand that a self-carry contract must be on file with Lauren's House.

* Unless otherwise noted above, my child has no illness, condition, or impairment that would make it unsafe for him/her to participate in sports or physical activities.

*I understand that the activities offered by the Program, including but not limited to sports, games, Christ centered activities, physical activities and field trips, entail inherent risks of injury or death and on behalf of myself and my child I voluntarily assume the risk of such injury or death to my child.

*FOR AND ON BEHALF OF MYSELF AND THE ABOVE-NAMED CHILD, I HEREBY WAIVE ANY AND ALL CLAIMS AND DEMANDS FOR RELIEF ARISING FROM OR IN CONNECTION WITH PERSONAL INJURY OR DEATH RESULTING FROM MY CHILD’S PARTICIPATION AT LAUREN'S HOUSE, REGARDLESS OF THE LEGAL OR FACTUAL BASES THEREOF, THAT COULD BE ASSERTED IN ANY FORUM OR MANNER WHATSOEVER, AND EXPRESSLY RELEASE, DISCHARGE, AND INDEMNIFY THE WIDEFIELD SCHOOL DISTRICT, ITS SCHOOL BOARD MEMBERS, AGENTS AND EMPLOYEES, PAST, PRESENT, AND FUTURE, FROM AND AGAINST ANY AND ALL CLAIMS AND DEMANDS WAIVED HEREIN REGARDLESS WHEN OR BY WHOM ASSERTED.

* I represent that I am the parent/guardian of the child named above, that I am over the age of eighteen (18) and that I have read the foregoing in its entirety and understand the meaning and effect thereof and intending to be legally bound here set in my hand on the date listed below.
During the summer, students are photographed participating in class projects and events. These photos might be used in newsletters, online, and our annual yearbook. Class activities may also be videotaped and shown during special school events. Therefore, permission is requested for your student to be photographed or video recorded during the summer. I agree to have my student's photo/video recorded during the summer. These videos and/or photos can be used for internal use at the school, as well as the annual yearbook, without compensation.
I agree to have my student's photo/video recorded during the school year. These videos and/or photos can be used externally in Lauren's House printed materials, website, Facebook page, Instagram, and/or the weekly Lauren's House eBlast, without compensation. *