Permission and Waiver of Liability and Authorization of Care

For good and adequate consideration, the sufficiency and receipt of which is hereby acknowledged, the Undersigned hereby authorize and grant to Providence Christian Academy, Inc., its employees, directors, agents and representatives (collectively referred to herein as the “Academy”) his/her permission to allow: (i) the Student to participate in on-campus and/or off-campus activities which are sponsored, approved and/or sanctioned by the Academy (the trips which may be away from the Academy’s premises)(referred to herein as the “Activity”); (ii) the Academy to secure, direct and authorize reasonable and/or necessary emergency medical attention and care for the Student, as determined in the sole discretion of the Academy, and where the Undersigned cannot be reached through reasonable efforts otherwise prior thereto; and (iii) the “Day Care Provider” or “Caregiver” (if any) listed (or such persons’ authorized representative(s)) and/or any of the persons listed as an authorized “Caregiver” to deliver and/or pick up the Student to or from the Academy’s premises under any circumstances. Should the Student be required to leave the event or function due to disciplinary reasons, any transportation expenses involved will be the parent’s financial responsibility and not the responsibility of the Academy, its employees, designated adult chaperones, or agents.

As part of the above-cited consideration, the Undersigned agrees to absolve, release, indemnify and hold the Academy harmless from any and all claims, demands, suits, actions, causes of actions, and liabilities, including attorneys’ fees, resulting from personal or property injury, loss or liability, and/or asserted by the Student, the Undersigned and/or any other party, arising from or related to the Activity (except where such claim is based upon the sole wrongful conduct or gross negligence of the Academy).

The Undersigned further agree to absolve, release, indemnify and hold the Academy harmless from any and all claims, demands, suits actions, causes of actions, and liabilities, including attorneys’ fees, arising from or related to emergency medical attention or treatment provided to the Student. The Undersigned agrees that if medical attention and/or treatment is provided to the Student, as contemplated above, the Academy will not be financially responsible for said medical attention and/or treatment of the Student. The Undersigned agrees to pay all financial obligations incurred as a result of such medical attention and/or treatment.

ELECTRONIC SIGNATURE

By signing below, I confirm that all information given is true and correct. By signing below, I acknowledge and agree that no certification authority or other third party verification is necessary to validate my electronic signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of my electronic signature. My consent to the electronic signature below applies only to this document and does not apply to any separate transactions or communications with the Academy.

Providence Christian Academy

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