Athletic Club of Bend


Youth Programs Informed Consent and Participant Release
I, the parent or guardian of the aforementioned child (participant),  understand the possibility of injuries resulting from activities sponsored by the Athletic Club of Bend (ACB). I hereby acknowledge and accept all risks and hazards incidental to participation in such activities. I hereby release, absolve, indemnify and hold harmless ACB and its directors, employees and agents from any injury, whether to person or property, of the participant resulting from such activities. In case of personal injury to participant, I hereby waive any and all claims against ACB, its directors, employees and agents. I hereby release from liability and waive any and all claims against any person who is involved in the transportation of participant in connection with ACB activities. I understand there is no insurance coverage provided by ACB for participant and that such coverage constitutes a responsibility of the participant and/or the undersigned. I hereby consent to emergency medical treatment of participant, including transportation, if deemed necessary by ACB staff, to assure prompt treatment and prevention of undue delay. I understand that either a licensed physician or trained emergency care technician may provide such treatment. 
 
I agree that ACB may use, produce, disclose and distribute participant’s name and/or likeness for promotional purposes or when required by law. 
 
I acknowledge that it is my responsibility to read, fully understand and accept behavioral, payment, and refund policies that are established for ACB activities before I register my child for such activities. I recognize that ACB is relying on such acceptance in permitting participant to engage in ACB activities.
 
ACB staff and management reserve the right to dismiss/dis-enroll a child from the camp program if the child's behavior is disruptive to the program and/or compromises the safety of themselves, other children and/or staff. Children suspended from the program will not qualify for a refund.
Electronic Signature and Acknowledgement
Enter today's date and your full name to certify that you are the legal parent or guardian of the aforementioned child and to acknowledge that your electronic signature is legally binding and will be treated the same as a hand-written signature.
Your Electronic Signature*