Electronic Consent Form

Solar Eclipse Consent Form

Consent to Participate in Viewing the Solar Eclipse/Activities Associated with the Solar Eclipse and Release and Waiver of Liability -KASB Legal Department

I,  (name of parent or legal guardian), the parent or legal guardian of  (name of student or students) give my consent for my child to participate in Viewing the Solar Eclipse and Activities Associated with the Solar Eclipse on August 21, 2017 (hereinafter the “Activity”).

Parent/Guardian does hereby release and forever discharge and hold harmless USD 460, Kansas (hereinafter the School District) from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from student’s participation in the Activity. Parent/Guardian hereby expressly and specifically assumes the risk of injury or harm related to Student’s participation in the Activity and releases the School District from all liability for injury, illness, death, or property damage resulting from the Student’s participation in the Activity.

 

Parent/Guardian understands that this Consent to Participate in Viewing the Solar Eclipse and Activities Associated with the Solar Eclipse and Release and Waiver of Liability (hereinafter Waiver) discharges the School District from any liability or claim that Student (or Parent/Guardian) may have against the School District with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Student’s participation in the Activity, whether caused by the negligence of the School District or its officers, directors, employees, or agents or otherwise. Parent/Guardian also understands that the School District does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance in the event of injury or illness.

I have read and understand the foregoing Waiver. I further give my legal consent and authorize any representative of the School District to authorize emergency medical treatment, including any necessary surgery or hospitalization, for my above-named child, for any injury or illness of an emergency nature he/she incurred while participating in the Activity by any physician or dentist licensed in accordance with the provisions of the Kansas Healing Arts Act, K.S.A. 65-2801 and any hospital. Parent/Guardian does hereby release and forever discharge the School District from any claim whatsoever which arises or may hereafter arise on account of first aid, treatment, or services rendered in connection with Student’s participation in the Activity. 

 

I agree to pay and assume all responsibility for medical and hospital expenses and any emergency service incurred on behalf of my child. I acknowledge and agree that the School District is not responsible for any medical or hospital expenses and/or charges that are incurred in the medical treatment or hospitalization of my child. If my child requires emergency medical treatment, I understand that school personnel will make a reasonable attempt to contact me to seek my permission to authorize treatment.  To facilitate contacting me, I agree to provide current work and home phone numbers to the school. A photocopy of this document shall have the same force and effect as the original. 

This form must be signed and returned to the school by August 21, 2017 by 9:00 am, if the student named above is to participate in the Activity.

Signed: 

Parent or Legal Guardian

 

Date:   



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