HELP Homeschool

Liability Release Form 2011/2012

  In consideration for being accepted for participation in  HELP Homeschool's program, and/or taking part in IEW, Literature and Composition, Galloping the Globe, 5 in a Row, Total IEW with Wordsmith, Ohio History, Mad Science, Musical Theater, Spanish and/or Art, Algebra 1 and 2, Saxon 8/7, Exploring North America, Lego Robotics 1 and 2, or any and all other classes including Science class at the Milford Christian Church, we(I), being 21 years of age or older, do for ourselves (myself) (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless, Margie Nesteroff (Teacher) Kay Goetz, (Teacher), Maureen Teller(Teacher), Dr. Frank (teacher), Bionic Becky (teacher), Sharon Francis (Teacher), Dena Martinelli (Teacher), Denise Owens (Teacher), Teri Cofskey (Teacher), Stephanie Mackris (teacher) Leslie Dorhout (Teacher), Tonya Preston (Teacher), Drake Planeterium and it's staff, Judy Young(Coordinator), Kim Conlin (Web Maintenance), Barb Woeste(Administration),  MR. Preston (teacher), Teresa Hinners (teacher), Emilie Carabello(teacher), as well as Parent Supervisors and/or Milford Christian Church and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above-described trip or activity.

Furthermore, we (I) (and on behalf of our [my] child-participant if under the age of 21 years) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and educational activities involved therein.

 

The undersigned further hereby agrees to hold harmless and indemnify said class, its teachers, directors, employees and agents, for any liability sustained by said class as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.

(If the participant has not attained the aged of 21 years):

We(I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our(my) permission(s) for him(her) to participate fully in said class, and hereby give our(my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs.

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(Type or print name of participant)

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(Parent[s] telephone)Home                                     Cell

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Father's First Name,                   Last Name                 Signature                   Date

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Mother's First Name,                    Last Name,               Signature                  Date

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Address

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