COVID Participation Waiver for Minors

NOTICE AND WAIVER FOR ALL VOLUNTARY ACTIVITY PARTICIPANTS at the
Battle Creek Public Schools Outdoor Education Center, Clear Lake Camp
10160 S M-37 Hwy, Dowling, MI 49050. PH: 269-721-8161. www.clearlakecamp.org

Name of Minor Name of Minor * First Last
Name of School (if applicable)
Grade (if applicable)
I agree that MINOR named above has my permission to participate in (Activity)
which will take place at BATTLE CREEK PUBLIC SCHOOL OUTDOOR EDUCATION CENTER (OEC) during the dates of
Student and parent/guardian have read and agree to follow OEC participation rules. I agree that participation in the above noted activity is voluntary and I have knowledge of and assume all risks for the activity to include injuries as well as exposure to communicable diseases, including COVID19. I certify that I understand current COVID19 risks and symptoms and current CDC guidelines. I certify that (MINOR) has not had any symptoms of COVID19/coronavirus nor been exposed to anyone that had such symptoms or diagnosis in the last 14 days. I agree to notify the OEC of any changes and I will NOT send (MINOR) to the activity if any symptoms develop or with notice of an exposure to COVID19 until (MINOR) has been medically cleared. I understand that this discharges the Battle Creek Public School District, OEC, ITS EMPLOYEES, and AGENTS from any liability or claim. OEC, ITS EMPLOYEES, AND AGENTS will not assume responsibility for any injury or illness incurred while participating or attending the program or any physically related activity. Certain risks are inherent during participation in these events. Nor will the OEC or its employees or agents be liable for lost or stolen items while participants are using the facilities or are on the premises. I waive all claims and release the Battle Creek Public School District, OEC and ITS EMPLOYEES and AGENTS from any and all injury, illness, or damage that (MINOR) or (I) may suffer as a result of participation or attendance in the activity. I agree to indemnify and hold the Battle Creek Public School District, OEC, ITS EMPLOYEES, and AGENTS from any liability or claim. OEC, ITS EMPLOYEES, AND AGENTS harmless from any claims presented on MY OWN BEHALF, or claims presented by (MINOR) or (MINOR’s) representative.
PARENT / LEGAL GUARDIAN signature. Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Email *
Date Date * / MM / DD YYYY