RBO Waiver for students in English

 

Student Info
Student Name *
Student Name
You can enter several names
Parent/Guardian Name *
Parent/Guardian Name
This form needs to be signed by an adult
More Students in the family?
Student Name (Optional)
Student Name (Optional)
Student Name (Optional too)
Student Name (Optional too)
I, the undersigned, give permission for my child to participate in the activities offered by Running for a Better Oakland. I know of no physical disorder that could keep my child from participating in this program. I waive any claim of liability against and agree to hold harmless, Running for a Better Oakland, and any other officer, agent, and/or employee thereof from claim of injury to participant arising out of or in any way connected with any class or activity offered by Running for a Better Oakland. I further agree that if my child should become injured while participating in the RBO program, I authorize transportation to any physician or surgeon licensed in the state of CA to perform emergency or surgical treatments within his/her judgment, may be necessary.
I, the undersigned, give permission to the medical personnel selected by Running for a Better Oakland, including without limitation, coaches, run mentors, volunteers and staff, to provide transportation and all necessary medical and dental care for the above named child. I hereby give permission to the medical care provider(s) selected by Running for a Better Oakland to secure and administer all necessary treatment, including hospitalization, for the child. This care may be given under whatever conditions are necessary to preserve life, limb, or well-being of the child.
I, the undersigned, understand that Running for a Better Oakland conducts evaluations to assess the quality of programs. I give permission for my child to be part of this program evaluation. I also understand that the information collected about my child will be kept confidential and that only persons connected with Running for a Better Oakland and the evaluation will have access to this information. I also give permission for any photograph, videotape, film audiotape or writing of said participant to be used in informational materials for Running for a Better Oakland.
"Signature" Box *
By checking this box, I hereby give the electronic equivalent of my signature and I confirm that I have read and agree to this Release and Waiver Agreement