10/23/2017: We are updating our calendar with upcoming events. Please check back soon for the newest information!

 

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WAIVER AND RELEASE FORM

Please read this form carefully and be aware in registering yourself, your child or ward for participation in the DREAM programs you will be waiving and releasing all claims for injuries you or your minor child/ward/adult son or daughter might sustain arising out of program participation.

As a participant or parent/guardian of a participant in the DREAM programs, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume full risk of any injuries, property damage or loss which I or my minor child/ward/adult son/or daughter may sustain as a result of participating in any and all activities connected with or associated with the DREAM programs.

I agree to waive and relinquish claims I or my minor child/ward/adult son or daughter may have as a result of participating in the program against the DREAM programs and its officers, agents, servants, volunteers, and employees.

I further agree to indemnify and hold harmless and defend the DREAM program and its officers, agents, servants, volunteers, and employees from any claims by other parties resulting from injuries, damages, and losses caused by me or my minor child/ward adult son or daughter arising out of, connected with, or in any way associated with the activities or program offered.

In the event of an emergency, I authorize the Dream Program to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my minor child/ward adult son or daughter’s immediate care and agree that I will be responsible for payment of any and all medical services rendered.

I have read and fully understand the above program details, waiver, and permission to secure treatment and shall not be modified orally.

 

 

IMAGE RELEASE

I give my permission for my minor child/ward adult so or daughter’s or my picture to be taken and used for publicity purposes and scrapbooking.

 

PARTICIPANT INFORMATION

Please provide the contact information for the participant, the person actually participating in one or more Dream Programs:

 

First Name Last Name

Age Birth Date Sex

 

REGISTRANT INFORMATION

Please provide the contact information for the registrant (parent, legal guardian or other individual) who should receive all correspondence from the DreamProgram regarding the participant.

 

First Name Last Name

Address

City State Zip

 

PHONE NUMBERS

Please provide the phone number(s) that should be used to contact the participant or the participants parent or legal guardian in the event that the Dream Program needs to initiate contact.

 

Primary

Secondary

 

EMAIL ADDRESSES

Please provide the email addresses that should be used to contact the participant (or) the participants parent or legal guardian in the event that the Dream Program needs to initiate contact.

 

Primary

Secondary

 

PROGRAM EXCLUSIONS

Please list any programs, classes, or activities that you specifically do not want your minor child/ ward, adult son or daughter to participate in:

 

This waiver is effective for two years after the date of signature, and you will be notified two months prior to its expiration when a new waiver will need to be signed. We will keep a copy of this on file please let us know if you would like a copy for your records.