Parental Consent & Release of Liability and Assumption of Risk Agreement
FOR GOOD AND VALUABLE CONSIDERATION, INCLUDING PERMISSION FOR the above registered minor (“the minor”) to participate in PG Breakers Basketball Camp and related activities, I, the parent/guardian of the minor for myself and on behalf of the minor:
Consent to the minor’s participation in the event and related activities;
Acknowledge that the minor and I fully understand that the minor’s participation may involve risk or serious injury or death, including economic losses, which may result not only from minor’s own activities, inaction, or negligence, but also from actions, inaction, or negligence of others, the condition of facilities, equipment, or areas where the event and related activities are being conducted, the rules of the activities, or this type of event and related activities:
Release, waive, discharge and relinquish Daniel Powers, PGUSD and its officers, employees and agents from any liability, loss, damage, claim demand or cause of action against them attributable to the minor’s participation in the event and related activities;
Covenant not to sue or present any claim for personal injury, property, damage or wrongful death for or on behalf of the minor against Daniel Powers and PGUSD or their officers, employees, and agents attributable to the minor’s participation in the event and related activities;
Agree that photographs, pictures, slides, movies or videos of the minor may be taken in connection with the minor’s participation in the event and related activities without compensation from Daniel Powers or PGUSD and consent to use of photographs, pictures, slides, movies or videos for any legal purpose;
Warrant that the minor is in good health and has no physical condition that would prevent the minor from participation in the event and related activities.
AUTHORIZATION TO TREAT: I authorize the adult agents and employee of PGUSD in charge of the program to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to my above named minor child under the general special supervision and upon the advice of a physician and surgeon licensed under the provision of the Medical Practice Act, pursuant to Section 25.8 of the California Civil Code and agree to be responsible for all cost thereby incurred.
IMPORTANT: THIS DOCUMENT RELIEVES DANIEL POWERS AND THE PACIFIC GROVE SCHOOL DISTRICT FROM LIABILITY FOR PERSONAL INJURY, WRONGFUL DEATH, ND PROPERTY DAMAGE CAUSED BY NEGLIGENCE. A PARENT, OR LEGALLY APPOINTED GUARDIAN MUST SIGN THIS DOCUMENT. LEGALLY APPOINTED GUARDIANS MUST FURNISH A CERTIFIED LETTER OF GUARDIANSHIP.
For payment, please send and check to:
Pacific Grove High School
Attn: Daniel Powers
615 Sunset Drive,
Pacific Grove, CA 93950
Make all checks payable to
Pacific Grove High School Boys Basketball