My Chinese Tree House

After-School Waiver



My Chinese TreeHouse After-School Program Waiver

I, the under signed parent/guardian of
do hereby consent to his/her participation in "My Chinese TreeHouse" After-School Program.
I acknowledge that participation in this camp may expose the above named student to the possibility of injury. I grant "My Chinese TreeHouse"
After-School Program Staff the authority to obtain emergency medical treatment as necessary to insure that the above named student is safe from further injury.
In consideration of "My Chinese TreeHouse" allowing this
student to participate in its After-School Program, I agree to waive and release "My Chinese TreeHouse" from all claims for damages that may arise, other than by negligence of "My Chinese TreeHouse", its employees and agents, as a result of my child’s participation in its After-School Program.
Media Waiver
I am aware that the above named student may appear in a photograph, or video, taken by After-School Program staff or local media and that photograph or video may appear in a variety of media sources on behalf of "My Chinese TreeHouse". "My Chinese TreeHouse" will not divulge your child(ren)’s name without written permission.
Transportation Waiver
I acknowledge that the above named student may be participating in activities, trips and events organized by "My Chinese TreeHouse". I am aware that the participation of my child(ren) may be outside the scope of his/her daily routine. I give permission for my child to travel by foot, automobile, or bus to a desired location.