INDEMNITY AND HOLD HARMLESS AGREEMENT
I/we hereby grant permission for my child to participate in Scott DurzoÕs Total Sport Camp recreation program for which I am registering. I agree to indemnify and hold harmless Scott Durzo, the City of Seal Beach, Rossmoor Community Services District, Los Alamitos Unified School District, and any other entity associated with the program, their officers, agents and employees from any liability, claim or action arising out of such participation. I understand that this program is not bound by the responsibilities and legalities that accompany a licensed daycare program. I further certify that my child is in good health and has no physical or other impediment, which would endanger him/her, or any other participant in taking part in such an activity.
CONSENT TO TREAT A MINOR
I certify that I am the parent or legal guardian of the
child being enrolled in this program. I hereby authorize
and consent to any x-ray examination, anesthetic, medical
or surgical diagnosis rendered under the general or special
supervision of any member of the medical staff and emergency
room staff licensed under the provisions of the Medicine
Practice Act or Dentist licensed under the provisions
of the Dental Practice Act and on the staff of any acute
general hospital holding a current license to operate
a hospital from the State of California Department of
Public Health. It is understood that this authorization
is given in advance of any specific diagnosis, treatment
or hospital care required but is given to provide authority
and power to tender care which the aforementioned physician
in the exercise of his/her best judgment many deem advisable.
It is understood that effort will be made to contact
the undersigned prior to rendering treatment to the patient,
but that any of the above treatment will not be withheld
if the undersigned cannot be reached. This authorization
is given pursuant to the provisions of section 25.8 of
the Civil Code, State of California.
This consent will remain in effect until rescinded in
writing.
CONSENT FOR FIRST-AID TREATMENT
I hereby authorize the staff to provide immediate first aid to my child in the event of illness or injury.
CONSENT FOR TRANSPORTATION
If this program provides for the transportation of my child, I hereby grant permission to Scott Durzo to provide such transportation.
PHOTOGRAPHIC RELEASE
I hereby give Scott Durzo, it's successors and assigns, the absolute and irrevocable right and permission with respect to photographs, videos, motion pictures, and/or sound recordings being taken of my child: (a) to use, reuse, publish and republish in whole or in part and (b) to use my child's name. I further release Scott Durzo and any other entity from any claims and demands arising out of the use of same.
