Summer Academy Permission Form - Hendricks CareerTek

Academy Permission Form

Student Name*
First Last
Parent/Guardian Name*
First Last
Parent/Guardian Email*
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By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending HCT or offsite location and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at HCT or offsite location may result from the actions, omissions, or negligence of myself and others, including, but not limited to, HCT employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at HCT, its partner locations referred to below, or participation in HCT programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless HCT, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the HCT, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any HCT program.
COVID-19 waiver
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending HCT or offsite location and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at HCT or offsite location may result from the actions, omissions, or negligence of myself and others, including, but not limited to, HCT employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at HCT, its partner locations referred to below, or participation in HCT programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless HCT, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the HCT, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any HCT program.
I give permission for my child to participate in the 2023 Summer Academy. Location will depend on which Academy my child participates in. Hendricks CareerTek 625 3rd Street, Suite 200, Beloit Blackhawk Tech 6004 S Cty Rd G, Janesville or Blackhawk Tech 15 Plumb St, Milton Various Geronimo locations Various locations with Welty Environmental Center ABC Supply Stadium CCI 3800 Milwaukee Rd, Beloit As a parent or guardian, I understand that Academy staff and volunteers will do everything possible to prevent any accidents over which they have control. However, I fully understand that participation in the program activities may involve some inherent risks to students regardless of all feasible safety measures that may be taken. As a voluntary participant in the program, I agree to accept responsibility for any loss, damage, or injury to my child that occurs during my child’s participation that is not the result of fraud, willful injury to a person or property, or the willful or negligent violation of a law by an employee or agent of Blackhawk Technical College or Hendricks CareerTek. I further authorize Academy staff to obtain emergency care for my child when it is deemed reasonably necessary for my child’s health or safety. I understand that Blackhawk Technical College or Hendricks CareerTek does not provide medical insurance nor assume any liability for injuries incurred traveling to, from and during the activity. By execution of this agreement, the participant assumes full risk and responsibility for any injuries or damages, which may occur to the participant. Lastly, I understand that if my child’s arrangements change it is my responsibility to notify the Hendricks CareerTek staff immediately.*
Permission to participate
I give permission for my child to participate in the 2023 Summer Academy. Location will depend on which Academy my child participates in.
Hendricks CareerTek 625 3rd Street, Suite 200, Beloit
Blackhawk Tech 6004 S Cty Rd G, Janesville or
Blackhawk Tech 15 Plumb St, Milton
Various Geronimo locations
Various locations with Welty Environmental Center
ABC Supply Stadium
CCI 3800 Milwaukee Rd, Beloit
As a parent or guardian, I understand that Academy staff and volunteers will do everything possible to prevent any accidents over which they have control. However, I fully understand that participation in the program activities may involve some inherent risks to students regardless of all feasible safety measures that may be taken. As a voluntary participant in the program, I agree to accept responsibility for any loss, damage, or injury to my child that occurs during my child’s participation that is not the result of fraud, willful injury to a person or property, or the willful or negligent violation of a law by an employee or agent of Blackhawk Technical College or Hendricks CareerTek. I further authorize Academy staff to obtain emergency care for my child when it is deemed reasonably necessary for my child’s health or safety. I understand that Blackhawk Technical College or Hendricks CareerTek does not provide medical insurance nor assume any liability for injuries incurred traveling to, from and during the activity. By execution of this agreement, the participant assumes full risk and responsibility for any injuries or damages, which may occur to the participant. Lastly, I understand that if my child’s arrangements change it is my responsibility to notify the Hendricks CareerTek staff immediately.
I understand that my child might leave the Academy site and I grant permission for my child to travel with the Academy group. Certain Academies may have a walking tour scheduled. The group will be supervised at all times by HCT staff.*
Permission to Travel
I understand that my child might leave the Academy site and I grant permission for my child to
travel with the Academy group. Certain Academies may have a walking tour scheduled. The
group will be supervised at all times by HCT staff.
Photo Release*
I grant permission to photograph my student for promotional and/or educational purposes
- YES
- NO
Please indicate if your child has any medical condition/concerns/food allergy that Hendricks CareerTek staff should be aware of during the course of this field trip:
Parent Signature*
Parent's Name*
Enter Today's Date*
MM slash DD slash YYYY
Student Signature if 18 and over
Student's Name*
Enter Today's Date*
MM slash DD slash YYYY
Phone
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