Parental Consent & Release of Liability
(for Minors) - 17 and Under
PARENTAL CONSENT AND RELEASE OF LIABILITY (for Minors)Extreme Community Makeover (ECM) deeply appreciates your willingness to serve as a volunteer. So that our volunteers have a clear understanding of what it means to be a volunteer for ECM, we ask you to carefully read this Parental Consent and Release of Liability for Minors, and if you agree with its terms, please sign below.
MY ROLE AS A VOLUNTEER WITH ECM:I understand that participating in Extreme Community Makeover (ECM) activities is a privilege. In consideration for that privilege, I am signing this Parental Consent and Release of Liability form on behalf of myself and my minor children participating in those activities. I also represent and warrant that my child(ren) is/are physically fit and have the physical and mental ability and skill to participate in all ECM activities. I understand that my child(ren) and I may participate in any number of activities some of which include, but are not limited to, the following recreational activities: Alley clean-ups, graffiti removal, painting, planting flowers, raking leaves, shoveling snow, trash pick-up, yard work, and other exterior home improvement/repair projects that might arise. I further understand that there are certain risks of physical injury or illness associated with these activities. In addition, I understand that there may be other risks inherent in or associated with these activities of which I may not be presently aware and which may or may not be foreseeable.
PERMISSION TO PHOTOGRAPH:I also hereby provide my consent to ECM to take photographs of me and/or my child(ren) and to use, publish, display and reproduce them in publications, videos, posters, brochures, advertisements, as well as internet-based publications of ECM without any further consideration, consultation or permission.
RELEASE OF LIABILITY:By signing this Parental Consent and Release of Liability, I expressly assume these risks, whether such risks are known or unknown to me at this time on behalf of myself and my minor child(ren). I further release ECM, including its directors, officers, volunteers, employees, and agents, from any claim, demands and/or liability that I or my child(ren) may have against them as a result of physical injury or illness incurred during participation in ECM activities. This release of liability shall include (without limitation) any claims for negligence and breach of fiduciary duty.
AUTHORIZATION FOR MEDICAL TREATMENT:With the increasing sophistication of the medical system, I understand it may be necessary to have a parental consent form in the event of an injury or condition requiring emergency medical treatment for my child(ren). This Parental Consent and Release of Liability gives ECM the permission to take my child(ren) to a medical facility and have any emergency treatment administered as advised by a physician or medical professional.
IN CASE OF EMERGENCY, I UNDERSTAND THAT EVERY REASONABLE EFFORT WILL BE MADE TO CONTACT ME; HOWEVER IF I CANNOT BE REACHED, I HEREBY GIVE ECM AND ITS REPRESENTATIVES THE PERMISSION TO ACT ON MY BEHALF IN SEEKING MEDICAL TREATMENT FOR MY CHILD(REN) IN THE EVENT THAT SUCH TREATMENT IS DEEMED NECESSARY OR ADVISABLE BY A PHYSICIAN AND/OR MEDICAL PROFESSIONAL FOR MY CHILD(REN)'S HEALTH, SAFETY AND WELFARE. I GIVE PERMISSION TO THOSE ADMINISTERING MEDICAL TREATMENT TO DO SO, USING THE MEASURES DEEMED NECESSARY BY A PHYSICIAN AND/OR MEDICAL PROFESSIONAL. I RELEASE ECM, ITS OFFICERS, DIRECTORS, EMPLOYEES, VOLUNTEERS, AND REPRESENTATIVES FROM LIABILITY IN ACTING IN THIS REGARD AND RENDERING SUCH MEDICAL TREATMENT.I represent that I am the parent/guardian of the child(ren) named below, who is/are under 18 years of age. In consideration for allowing my child(ren) to participate in ECM activities, I hereby consent to the foregoing on behalf of my child(ren) and agree that this Parental Consent and Release of Liability shall be binding upon me, my child(ren), heirs, legal representatives and assigns. I shall defend, indemnify and hold harmless ECM and its officers, directors, volunteers, employees and agents, from any liability asserted by my child(ren) and/or anyone acting on his/her/their behalf, whether before or after my child(ren) reach majority, including reasonable attorney's fees and costs.
***Please complete this form for the minor participating***