My child has permission to participate in activities provided by agencies participating in the Recreation/Enrichment Programs. I acknowledge that my child must follow all of the rules in order to participate. In the event that I cannot be reached in an emergency, I hereby authorize that medical/surgical treatment be administered to my child at my expense. I assume all risks and hazards incidental to and inherent in participation in this program. I hereby waive and release the City of Springfield and its officials, employees and officers from any claims that arise out of a decision to authorize medical/surgical treatment, as well as claims arising out of any personal injury or property damage related in any way to my child’s participation in the program. I hereby indemnify and hold harmless those agencies or organizations providing activities for the Recreation/Enrichment Program from claims of third parties arising out of the decision to authorize medical/surgical treatment, or my child’s participation in the program. My name below authorizes the Springfield School Department to release my child’s social security, SASI, State ID numbers, and necessary school documents to the REACH and or CDGB partner program network. The information gathered will be used to apply for and report in grants the city receives. My full name above certifies that I have read and understood this disclaimer, and all the program rules and regulations.
