I do voluntarily consent to my son’s or daughter’s good health and to participation in all RYLA activities, including the ropes course, to be held at Grizzly Creek Ranch, Portola, California on one of the afore mentioned dates. I assume responsibility for any medical or treatments fees or costs incurred directly or indirectly because of said minor’s participation.
I also authorize the representative(s) of Rotary Districts 5180/5190 to arrange for professional care and treatment in case of a medical emergency. I hereby give my permission to the physician selected by the Rotary representative to hospitalize, secure professional treatment for and/or to order injections, anesthesia, and/or surgery for the minor named above.
RELEASE, ASSUMPTIONS OF RISK AND AGREEMENT TO HOLD HARMLESS
In consideration of the sponsoring Rotary Club, Rotary International District 5180 and/or 5190, I permit my child to participate in RYLA and to engage in all related activities. I hereby assume the risk associated with participation and agree to hold the RYLA 5180/5190, Inc., the sponsoring Rotary Club, Rotary International Districts 5180 and 5190, their committees, employees, agents, representatives and volunteers harmless from any and all liabilities, actions, causes of action, claims or demand of any kind and nature whatsoever that may arise by or in connection with my child’sparticipation in any activities related to RYLA, including the full day Ropes Challenge Course. The terms here shall serve as a release and the assumption of the risk for my child, his or her heirs, estate, executor, administrator, and assignees as well as members of my family.
I grant Rotary Districts 5180 and 5190 and the sponsoring Rotary Club permission to use the image of the above-named minor for educational and promotional purposes. In addition, Rotary Districts 5180 and 5190 may contact the above-named minor regarding other Rotary programs, including, but not limited to, Interact, Rotaract, speech contest, musical performance contest and scholarship opportunities.