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Liability Release, Emergency Medical Treatment Agreement, and Photo Release

Please correct the field(s) marked in red below:

PLEASE NOTE: This liability release form is not a class registration. If you have not already registered your child for the desired class, you may register online or call our office at 360.383.3200 and we’d be happy to assist you.

My child has my permission to attend the following class(es)/camp(s) at Whatcom Community College. Please note: (*) indicates responses are required.

 *
PLEASE NOTE: This liability release form is not a class registration. If you have not already registered your child for the desired class, you may register online or call our office at 360.383.3200 and we’d be happy to assist you. My child has my permission to attend the following class(es)/camp(s) at Whatcom Community College. Please note: (*) indicates responses are required.

MEDICAL RELEASE

Medical release on behalf of minor and hold harmless agreement

I hereby authorize Whatcom Community College to procure medical or hospital care for my child in the event of injury or illness. I understand and agree that I am financially responsible for any care so procured.

I have disclosed below all pertinent medical history or conditions concerning my child which could be of use to a treating medical provider.

I UNDERSTAND AND DO HEREBY AGREE TO ASSUME ALL OF THE DIRECT RISKS AND ANY OTHER INDIRECT RELATED RISKS WHICH MAY BE ENCOUNTERED BY MY CHILD WHILE PARTICIPATING IN THE ABOVE ACTIVITY. 

I hereby hold harmless and waive any and all claims against Whatcom Community College, its staff, volunteers and leaders for any accident, bodily or personal injury, damage to or loss or theft of any property, illness, or death of any person, including without limitation demands, liabilities, damages, judgments, losses, costs, expenses and/or penalties, including attorneys’ and consultants’ fee and disbursements, which arise out of attending the above class.

I further state that I HAVE CAREFULLY READ THE FORGOING RELEASE AND KNOW THE CONTENTS THEREOF AND AM SIGNING THIS RELEASE AS AN ACT OF MY OWN FREE WILL. This is a legally binding agreement which I have read and understand.

 *
MEDICAL RELEASE Medical release on behalf of minor and hold harmless agreement I hereby authorize Whatcom Community College to procure medical or hospital care for my child in the event of injury or illness. I understand and agree that I am financially responsible for any care so procured. I have disclosed below all pertinent medical history or conditions concerning my child which could be of use to a treating medical provider. I UNDERSTAND AND DO HEREBY AGREE TO ASSUME ALL OF THE DIRECT RISKS AND ANY OTHER INDIRECT RELATED RISKS WHICH MAY BE ENCOUNTERED BY MY CHILD WHILE PARTICIPATING IN THE ABOVE ACTIVITY. I hereby hold harmless and waive any and all claims against Whatcom Community College, its staff, volunteers and leaders for any accident, bodily or personal injury, damage to or loss or theft of any property, illness, or death of any person, including without limitation demands, liabilities, damages, judgments, losses, costs, expenses and/or penalties, including attorneys’ and consultants’ fee and disbursements, which arise out of attending the above class. I further state that I HAVE CAREFULLY READ THE FORGOING RELEASE AND KNOW THE CONTENTS THEREOF AND AM SIGNING THIS RELEASE AS AN ACT OF MY OWN FREE WILL. This is a legally binding agreement which I have read and understand.

Parent/Guardian Contact information

 *
Parent/Guardian Contact information

PHYSICIAN/INSURANCE INFORMATION 

Please note that our instructors and staff are not authorized to administer any medications to your child, whether prescribed or over the counter. If your child requires medication during class time, we request that a parent or authorized person come to class to administer as necessary.

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PHYSICIAN/INSURANCE INFORMATION Please note that our instructors and staff are not authorized to administer any medications to your child, whether prescribed or over the counter. If your child requires medication during class time, we request that a parent or authorized person come to class to administer as necessary.

AUTHORIZED TO PICK UP 

Please list the name, phone number and relationship for any person who is authorized to pick up your child at the end of the class. Your child will only be released to you or those on this list.

AUTHORIZED TO PICK UP Please list the name, phone number and relationship for any person who is authorized to pick up your child at the end of the class. Your child will only be released to you or those on this list.

PHOTO RELEASE

I hereby give permission to Whatcom Community College to utilize photographs, video, and audio taken of my child during this class (or classes) for recruitment materials WCC may develop. I further will allow this material to become part of copyrighted work in the name of Whatcom Community College or its designee for educational purposes.

 

I hereby release and discharge Whatcom Community College from any and all claims and demands arising out of, or in connection with, the use of the photographs and video footage, including and without limitation, any and all claims for libel or invasion of privacy.

 *
PHOTO RELEASE I hereby give permission to Whatcom Community College to utilize photographs, video, and audio taken of my child during this class (or classes) for recruitment materials WCC may develop. I further will allow this material to become part of copyrighted work in the name of Whatcom Community College or its designee for educational purposes. I hereby release and discharge Whatcom Community College from any and all claims and demands arising out of, or in connection with, the use of the photographs and video footage, including and without limitation, any and all claims for libel or invasion of privacy.
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