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Consent, Release and Assumption of Risk for Student Participation at CBI Forest School

Child's Name 1

Child's Name 2

Child's Name 3

Parents/Guardian's Name

I. General Consents and Acknowledgements
A. I/We understand that CBI is registered with the state as a religiously exempt child day care center and not a state-licensed child day center.
B. I/We agree to abide by the school policies as specified in the Family Handbook including those outlined in the Health and Safety Policy.
C. I/We give permission for photographs of my/our child(ren) and artwork by my/our child(ren) to be used for promotional purposes.
D. I/We agree to pay a late fee if my/our child(ren) is/are not picked up as scheduled: $30 plus $1/ minute after the first five minutes.

II. Health & Safety Consents, Acknowledgements and Waivers
A. I/We understand that sick children may not attend school
B. I/We agree to come promptly when notified my/our child(ren) is/are sick.
C. I/We give permission for CBI to apply sunscreen to my/our child(ren).
D. I/We give permission for CBI to apply insect repellant to my/our child(ren).
E. I/We understand that medication can be administered to my/our child(ren) by school personnel only with fully completed medication forms.
F. We give permission for my/our child(ren) to walk off site (CBI Downtown, Lewis & Clark Center, MACAA) to neighborhood nature areas.
G. As required by Virginia law, my/our child’s immunization record is up to date and on file at CBI.
H. I/We authorize CBI to secure emergency medical and/or emergency surgical treatment for the above named minor child(ren) while said child(ren) is/are in the care of CBI.
I. I/WE agree to release, discharge, hold harmless and indemnify CBI, it’s agents, employees, officers, volunteers, insurers and others acting on CBI's behalf (the Releases”), of and from any and all claims, demands, causes of action and/or legal liabilities for injuries to or death of my/our child(ren) (collectively, “Losses”) occurring during, or resulting from, or participation in CBI, even if the Losses are alleged to be the fault of or alleged to be caused by the negligence or carelessness of the Releases. I/We expressly assume the risks associated with my/our child(ren)’s participation in CBI and all activities that will be part of the program, including extensive outdoor activities, including risk of temporary or permanent injury and death.
J. CBI has put in place protective measures to reduce the spread of infectious diseases which are outlined in the CBI Health and Safety Guidelines (the “Guidelines”), a copy of which has been provided for your review by CBI.

Please write special exceptions below regarding photography

Untitled checkboxes field

I/We acknowledge that I/we have read the Guidelines and I/we agree, represent, and warrant that my/our child and family shall follow the Guidelines and any procedures instituted by CBI. Furthermore, I/we acknowledge and agree that CBI may revise its Guidelines at any time and further agree that it is my/our responsibility to review and familiarize myself/ourselves with any updated Guidelines and to comply with such revised Guidelines.

I/We understand and agree that failure to comply with the Guidelines may result in my/our child(ren)’s dismissal from CBI and that I/we will not be entitled to any refund of prepaid tuition.

I/We acknowledge and understand that CBI cannot prevent the possible transmission or contracting of viruses to my/our child(ren) or family. I/we further acknowledge and understand that, by enrolling my/our child(ren) at CBI, I/we may increase the risk of my/our child(ren) or family contracting viruses and I/we expressly assume this risk to my/our child(ren) and myself/ourselves.

Initials

K. I/We agree to release, discharge, hold harmless and indemnify the Releases, of and from any and all Losses occurring during, or resulting from, or participation in, the above-mentioned program or activity and related in any way to closures, even if the Losses are alleged to be the fault of or alleged to be caused by the negligence or carelessness of the Releases. I/We covenant and agree not to: (a) sue any of the Releases in connection any Losses; or (b) challenge the enforceability of all or any portion of this Consent, Release and Assumption of Risk for Student Participation in CBI Forest School (this “Agreement”).

Initials

I/We have carefully read and voluntarily signed this Agreement and further agree that no oral representations, statements or inducement apart from the foregoing written Agreement have been made. I/we am/are giving up valuable legal rights, including the right to recover damages from CBI in case of illness, injury, or death. I/We understand that this document is a promise not to sue and a release of and indemnification for all Losses (as defined above). I/We understand that this agreement is made on behalf of my/our entire family including my/our minor child(ren) and I/we represent and warrant to CBI that I/we have full authority to sign this agreement on behalf of such minors. I/We agree that, in the event that any provision of this Agreement or the application thereof to any person or circumstance shall to any extent be held to be invalid or unenforceable, then the remainder of this Agreement will not be affected thereby and each provision of this Agreement will be valid and enforceable to the fullest extent permitted by law.

Parent/Guardian 1

Signature

Parent/Guardian 2

Signature