Youth Education Liability Waiver

Page 1

Parent/Guardian Consent to Participation, Treatment, Waiver and Release





--- One Student per Form ---


PLEASE READ AND UNDERSTAND THIS POLICY BEFORE AGREEING

This Agreement must be completed by the Parent(s), Legal Guardian in order to participate in the activities associated with the program.
  • I am the parent/guardian of the above named Participant who is under 18 years of age. I am familiar with the curriculum and the activities which take place in the above named Program and hereby give consent for the Participant to participate in the Program.  I understand that participation in the Program can include foreseeable and unforeseeable risks and other hazardous activities inherent in the program, which may expose the participant to illness, injury or death.
  • I acknowledge that if the course is taught in an online format and at a location chosen by me, I am responsible for the supervision of the Participant during his/her participation in the Program.
  • I state that Participant is free from any health problems, including but not limited to heart or respiratory problems that could prevent Participant from safely participating in any of the activities.
  • I hereby give my express consent in the event of injury at the University of Utah or business partner location(s) for the University to obtain for the Participant any necessary emergency aid, anesthesia and/or operation, if in the opinion of the attending physician, such treatment is necessary.
  • I certify that participant has medical insurance (provide insurance information below) and otherwise agree to be personally responsible for costs of any emergency or other medical care that Participant receives. I agree to release, waive, covenant not to sue, and hold harmless the University, and all of their officers, employees and agents (collectively the "Releasees") from the cost of any medical care that Participant receives as a result of participation in the Program.
  • I understand and acknowledge that the University of Utah is not an insurer of Participant’s behavior, actions or participation in the Program and that the University assumes no liability whatsoever for personal injuries or property damages to Participant or to third persons arising out of Participant’s participation in the Program activities.
  • I agree to release, waive, covenant not to sue, indemnify and hold harmless the Releasees from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, injury, illness, attorney’s fees or harm of any kind or nature to me arising out of Participant’s participation in the Program and excepting only such loss, damage or injury as may be caused by the sole negligence of any Releasee.  This release extends to any claim made by parents or guardians or their assigns arising from or in any way connected with the aforementioned activities.
  • I agree that the site of any lawsuit arising out of or related to participation in the Program shall be Utah and that this Agreement will be governed by and construed in accordance with the laws of the state of Utah, without application of any principles of choice of law.
  • I shall pay any attorney fees or costs incurred by the University in enforcing this Agreement.
  • If any portion of this Agreement is held to be invalid by a court of law, then it is agreed and intended that all the remainder shall, notwithstanding, continue in full force and effect.
  • I acknowledge that I am at least eighteen (18) years of age and I have read this document in its entirety and fully understand the terms of this Agreement.
*The University of Utah is committed to protecting minors participating in University programs. if you, as a parent/guardian, have concerns about any misconduct in connection with the above named Event/Program, please contact the University's Office of Equal Opportunity and Affirmative Action at 801-581-8365.






Page 2

Computer Acceptable Use Policy


This form must be signed by a parent or guardian before the student can use a computer. The form will be kept on file for the current semester and is intended to be used for each course requiring computer access even though not all the items below are relevant for every course.

Issues & Responsibilities: The Internet contains a wealth of information as well as material that is objectionable from many points of view. Please note that the University's computer labs are unfiltered. Instructors will closely monitor student use. Each student having Internet access will participate in a discussion with his or her instructor regarding acceptable behavior and use of the network. Where relevant to the course, students will discuss with their instructor potential dangers, threats, and consequences that can arise with the use of social media sites. Internet access is to be used only for teacher directed activities. If a student is in violations, his or her Internet access will be terminated and future access could be denied.

If relevant to the course(s) in which I am a participant, I agree to the following:
  • I will visit websites only as relevant to the course(s) in which I am participating.
  • My course work may be published to a public blog. I understand that editorial access to the blog is instructor-controlled, but that the content can be viewed by public (including my family and friends!). The University is under no obligation to maintain the blog after the conclusion of the course(s).
  • I may use an existing or create a new email account for purposes of registering for cloud-based editing software and/or accessing social media sites, including but not limited to Twitter, Facebook, and blogs.
  • I may use or create social media accounts, including but not limited to Twitter, Facebook, and blogs.
  • I may create, use and control an online portfolio of the work I create during the course(s).
I agree to the computer use policy and provisions as outlined above. I understand and agree to follow instructions for acceptable use of the Internet. I understand that any violation will result in the loss of Internet access. I agree to report any misuse of Internet resources to my instructor.

I have explained the policy to my minor child and have discussed with him/her the potential risks of participation.

Parent or Guardian: As the parent/guardian of the student-user named above, I have read the above statement and I hereby give my permission for my child to access the Internet and agree to the computer use policy and provisions as outlined above.

Page 3

Additional Participant Information


Please use this form to share any information that can help Youth Education provide the best experience for child(s).

Helpful information to include:
  • Physical health or medical details
  • Mental or emotional health details
  • Behavioral details
  • Individual Education Plan details
  • Any other information you’d like to provide
Why do we ask for this information?

When you send your child to camp, you entrust us with their care. We take this responsibility seriously, but we are only as good as the information that we are given. Therefore, we ask that you work with us to provide detailed and accurate information so we can better prepare our team to create a positive and rewarding experience for your child.

When we don't know about a particular child's needs, we may not be able to respond to their behavior properly. The better prepared we are before camp, the better we can help your child be successful once they are here.

Note: If your student requires special accommodations, please contact the Youth Education office at 801-581-6984 well in advance. To get a better idea of what accommodations are available, please contact the Office of Equal Opportunity at 801-581-8365.


Page 4

Secondary Emergency Contact:




Participant has been advised to maintain health and accident insurance to cover the cost of treatment in the event of any injury or illness.