In addition to parents / guardians listed above
Such as ADD, ADHD, allergies, diabetes, seizures, asthma, etc.
Programs, services and facilities are available for individuals with disabilities.
In case of emergency, I give the City of Irving, and it’s staff the authority to call for medical attention for my son/daughter while participating in any program, field trip or special event with the Cimarron Park Recreation Center After School Program or any other City of Irving park or facility.
I have read and fully understand and agree to all of the guidelines and regulations regarding the City of Irving Programs. I also agree to follow the guidelines set forth for After School Program.
I release the City of Irving, its employees and volunteers from all responsibility for any accident or injury that may occur while my son/daughter participates in planned activities at any city of Irving facility, field trip, or water park. I also do not hold the City of Irving, it’s employees and volunteers responsible for any accident or injury to my son/daughter while transporting to and from planned activities, field trip or water park unless negligence is proven.
By my signature on this form, I authorize the City of Irving and its agents and assigns (hereinafter City of Irving) should it choose, to use my [or my child’s or dependent’s (as applicable)] name, picture, voice, verbal statements, and/or portraits (video or still) in any promotional and/or educational printed or electronic piece that furthers the City of Irving’s public relations and/or educational efforts during this and subsequent years. This includes, but is not limited to, external news media outlets, printed materials, broadcast, web site, brochures, displays, newsletters, or other means of communicating with the public about programs and services in Irving. I further understand that the pictures, recordings, articles, copy, or other means of communications may or may not personally identify me [or my child or dependent (as applicable)]. I release to the City of Irving and consent to the use of my [or my child’s or dependent’s (as applicable)], name, picture, voice, verbal statements, or portraits (video or still).
I waive to the fullest extent that I may lawfully do, any causes of action in law or equity that I may have or may hereafter acquire against the city of Irving arising out of or in connection with the use of my [or my child’s or dependent’s (as applicable)] name, picture, voice, verbal statements, or portraits (video or still).
I further affirm that I understand and agree that:
* indicates a required field