Parent/Guardian Consent* I agree. I understand that my child’s participation in the Program is voluntary and that as I condition of my child’s participation, I agree to comply with all Program requirements including, but not limited to: (a) accurately completing all registration forms in a timely manner, (b) ensuring that my child is aware of the Program’s standards of conduct; (c) and immediately notifying the Program Administrator of any concerns related to the health, safety or security of my child, other participants, or Program staff. I understand that as part of my child’s participation in the Program that there are dangers, hazards and inherent risks to which my child may be exposed, including the risk of serious physical injury, temporary or permanent disability, and death, as well as economic and property loss. I further realize that participating in the Program may involve risks and dangers, both known and unknown, and I have chosen to allow my child to take part in the Program. Therefore, I, and on behalf of my child, have determined that it is reasonable to accept all risk of injury, loss of life or damage to property arising out of training, preparing, participating, and traveling to or from the Program and I do voluntarily accept and assume those risks. I release the Pine Rest Christian Mental Health Services, its Board of Directors, Administration, Faculty, Staff, Graduate Students, and all other officers, directors, employees, volunteers and agents from any claims or liability arising from my child’s participation in the Program, provided that such claim is not due to the gross and sole negligence of the released parties. In the event of an accident, serious illness, or medical emergency (as determined by Pine Rest staff), I authorize representatives of Pine Rest to obtain medical attention for my child, which may include evaluation and/or treatment. I understand that I will be notified of the situation as soon as practicable, but that my child may receive treatment before I am able to be notified. I hold harmless and agree to indemnify Pine Rest from any claims, causes of action, damages and/or liabilities, arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries to my Child that may occur during his/her participation in the Program. I also agree to indemnify Pine Rest and all of its employees and agents from any financial obligations or liabilities that my child may cause while participating in the Program, including attorney’s fees and court costs resulting from his/her misconduct, errors, or omissions. I acknowledge that Pine Rest employees have undergone criminal background checks, but other participants of the event may not have undergone background check screening. As such, Pine Rest makes no assertions or assurances with respect to other participants. This Agreement is governed by and construed under the laws of the State of Michigan without regard for principles of choice of law. Any claims, demands, or actions arising under this Agreement must be brought in the Michigan Court of Claims or a court with applicable subject matter jurisdiction sitting in the state of Michigan and I consent to the jurisdiction of a Michigan court with appropriate subject matter jurisdiction. Validity of consent concludes at 18th birthday or upon exiting the program, whichever comes first. I agree that the terms and conditions of this Agreement are binding on my representatives, heirs and assigns.
