Parent's Night Out
Sponsored by the American Chemical Society
Student Affiliate Chapter at Angelo State University
| Date: | April 21st |
| Time: | 6:30-9:30 PM |
| Location: | Angelo State University Center for Human Performance (Gym) |
| Age group: | Kindergarten-5th grade |
| Fee: | This event is being held for free as a courtesy of our student club. Donations will be accepted. |
Purpose
This is an opportunity for parents to provide their children with an educational opportunity and the chance to provide themselves an opportunity to enjoy some "away time." In celebration of Earth Day, the ACS Student Affiliates Chapter at Angelo State University is offering a Parent's Night Out on April 21st. Activities planned for this evening will have a focus on science and its relationship to the earth.
Registration Form
| Parent's Name(s) | ________________________________________________________ |
| Child's Name | ______________________ (NOTE: One registration form per child) |
| Child's Grade Level | ______________________ |
| Emergency Number | ______________________ (must be available between 6:30 and 9:30 PM) |
| Home Number | ______________________ |
| Work Number | ______________________ |
| Food Allergies | ____________________________ ____________________________ |
| Medication Allergies | ____________________________ ____________________________ |
| Other conditions | ____________________________ ____________________________ |
Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement
In consideration of participating in Parent's Night Out I represent that I understand the nature of this activity and my child is qualified, in good health, and in proper physical condition to participate in such an event. I fully understand that this activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my child's own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the "releasees" named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility of losses, cost, and damages I incur as a result of my child's participation in this activity.
I hereby release, discharge, and covenant not to sue the American Chemical Society or Angelo State University, its Board of Regents, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, and sponsors, advertisers, and, if applicable, owners and lessors of premises on which the activity takes place, (each considered one of the "RELEASEES" herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the "releasees" or otherwise, including negligent rescue operations. I further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may incur as the result of such claim. I have read this waiver and I understand that I have given up substantial rights by signing it and have signed it freely and without an inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.
I do understand the nature of the activities and my child's experience and capabilities and believe the child to be qualified to participate in such activity. I hereby Release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses or damages on the child's account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the child, or anyone on the child's behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any Releasee may incur as the result of any such claim.
______________________________
Parent or legal guardian signature
I acknowledge reading the release and waiver of liability, assumption of risk and indemnity
agreement above.
Parent or legal guardian signature
In order to help assure that the Parent's Night Out activity finishes promptly at 9:30 PM, I agree to pay the Angelo State University Student Affiliate's club $1.00 for each minute past 9:30 PM that I am not present to pick up my child.