Section 1 of 1 in this document

YOUTH PERMISSION SLIP, WAIVER & RELEASE

I hereby give permission for my child to attend and participate in the Charlotte-Mecklenburg Animal Care & Control volunteer program.

Today's Date

Date Picker

Name of Parent or Legal Guardian

Name of Child

In consideration for the opportunity for my child to participate in the program, I consent to the following:

1. On behalf of my child, myself, my administrators, assigns, executors, successors, heirs and next-of-kin, I hereby waive, release and discharge the City of Charlotte, General Services, Charlotte-Mecklenburg Animal Care & Control and/or its directors, officers, employees, volunteers, representatives and agents from any and all liability, including but not limited to, liability arising from the negligence or fault of the City of Charlotte, General Services, Charlotte-Mecklenburg Animal Care & Control and/or its directors, officers, employees, volunteers, representative and agents for any and all injuries, damages or losses of any kind, suffered by myself, my child or others as a result of my child's participation, including travel to and from the program. I understand that there is a risk of injury, including physical harm or injury, or damage to personal property, and that I hereby assume all such risks of my child's participation.

2. On behalf of my child, myself, my administrators, assigns, executors, successors, heirs and next-of-kin, I hereby waive, release and discharge any and all rights and claims of damages against the City of Charlotte, General Services, Charlotte-Mecklenburg Animal Care & Control and/or its directors, officers, employees, volunteers, representatives and agents for any and all injuries, damages or losses suffered by myself, my child or others as a result of my child's participation, including travel to and from the program.

3. I certify that I or my child have not been advised not to participate by a qualified medical professional and that there are no health-related reasons or problems that preclude my child's participation in the program.

4. I acknowledge that this waiver and release will be used by the City of Charlotte, sponsors and organizers of the program and that it will govern my and my child's actions and responsibilities in the program.

5. I acknowledge that the City of Charlotte, General Services, Charlotte-Mecklenburg Animal Care & Control and/or its directors, officers, employees, volunteers, representatives and agents are NOT responsible for any errors, omissions, acts or failures to act for any party or entity conducting activities on their behalf.

6. I hereby agree to indemnify, defend and hold harmless the City of Charlotte, General Services, Charlotte-Mecklenburg Animal Care & Control and/or its directors, officers, employees, volunteers, representatives and agents from and against any and all "charges" (as defined below) paid or incurred as a result of any claims, demands, lawsuits, actions or proceedings asserted or brought as a result of my child's participation in the program. "Charges" means any and all losses, damages, costs, expenses (including reasonable attorneys' fees), obligations, duties, fines, penalties, interest charges and other liabilities (including settlement amounts).

7. I hereby consent to my child receiving medical treatment that may be deemed advisable in the event of injury, accident and/or illness during participation in the program.

8. I understand that while participating, I or my child may be photographed and/or audio/video recorded. I agree to allow my or my child's photo, video, audio recording or film likeness to be used for any legitimate purpose by Charlotte-Mecklenburg Animal Care & Control.

9. This waiver and release shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. The laws of the State of North Carolina shall govern this waiver and release.

My child is covered with medical insurance

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A WAIVER AND RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Parent/Legal Guardian Signature

Parent/Legal Guardian Signature
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