Waiver High School Step #3 Form Authorization*This form must be filled out by the parent or guardian if the participant is under the age of 18.Yes, I am a parent or guardian.No, I am the participant.Please have a parent or guardian complete this form.Participant Name* First Last Full Name of Parent or Guardian Completing Form First Last Email for Conformation Receipt* Media ReleaseSay Cheese!*I agree that images and audio taken during summer program activities through video and photos may be used and distributed for publication as deemed appropriate by Northland College without any limitation in space or time, and waives any rights of compensation or ownership thereto. YesNoStudent Zero Tolerance AgreementNorthland summer programs are designed to provide experiences that promote learning and team building in a safe, respectful, and positive environment. We ask that both participant and parent/guardian sign the agreement below. By signing this agreement, it is fully understood that Northland College summer programs has ZERO TOLERANCE for drugs; alcohol; and any behavior, speech, or action deemed as disruptive, disrespectful, or bullying toward instructors, participants, staff, on Northland’s campus. If such occurs, the student may be asked to leave the program.Acknowledgement of Zero Tolerance Agreement* The participant understands and has read the above student zero tolerance agreement. Expectation of Conduct The participant will cooperate with and follow the direction of program staff, instructors, and activity facilitators. The participant will be on time and take part in all scheduled activities including instruction, tours, recreation, and evening programs. Those not feeling well or having any physical or emotional safety concerns must immediately inform program staff or instructor. The participant will be respectful of and avoid harmful behavior to self, other participants, program staff, instructors, guest speakers, private and public property, and facilities. The participant will remain in the assigned program area and assigned residential room throughout the session. Room switching and unauthorized absence from activities or residential room after “lights out” is not permitted. The participant will abide by established lights out and quiet times and will respect the privacy of others. The participant will not visit any residential rooms or bathroom of members of the opposite sex. The participant will refrain from engaging in activities if he or she does not fully understand the activity instructions or the possible consequences of the risk involved in the activity. In addition, the participant will seek out clarification from the staff or instructor before continuing with the activity. The participant will behave in accordance with applicable federal and state laws, and abide by all expectations and Policies listed in the summer handbook. Participants and their families understand the program staff roles are: To serve as a supervisor and mentor for the participants; To maintain consistent supervision of participants to monitor safety, health, attitude, behavior, etc. To monitor all prescription medication and medical care; To make appropriate decisions in emergency situations for the wellbeing of participants.Acknowledgement of Expectation of Conduct* The participant understands and has read the above expectation of conduct. Assumption of Risk, Waiver of Liability, & Agreement not to SueParticipating in Northland College summer programs may require the participant to be outdoors or engaged in outdoor adventure activities. Consequently, the participant might be exposed to certain risks due to the activities involved, unpredictable weather conditions, natural hazards, or human hazards. Participation in the summer program is entirely voluntary and involves a risk of injury and/or illness due to certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries, such as, but not limited to, contact with other individuals engaged in summer program activities, impact against objects, broken or improperly used equipment, weather hazards, environmental hazards, falls, falling objects, and separation from the group during summer program activities. The specific risks vary from minor injuries such as scratches and sprains, to major injuries such as eye injury or loss of sight, broken bones, joint or back injuries, heart attacks, and concussions, to catastrophic injuries including paralysis and death. The following is a partial list of some of the potential hazards and potential resulting injuries inherent to being out of doors and engaging in summer program activities. It is not a complete list of all potential injuries: Head, neck, and spinal injuries which may result in complete or partial paralysis and/or brain damage due to falls, moving water, or other forces. Injury caused by falls or encounters with trauma-producing objects found in camp, nature, in and around vehicles, or elsewhere even while engaged in seemingly mundane, non-threatening activities. Drowning and injuries caused by water. Injury caused by burns caused by contact with flames from a camp stove, camp or forest fire or lightning. Injury caused in an automobile accident, or while loading or unloading vehicles or trailers. Illness from venom, rabies, Lyme disease, or other diseases, allergic reactions to insects, animals, plants, etc. Injury from hunting related accidents as some activities occur during various hunting seasons. Illness or infection. Exacerbation of underlying medical conditions, such as epilepsy. Injury to soft tissue, bones, joints, ligaments, muscles, tendons, and other parts of the musculoskeletal system. Communicable diseases such as cold/flu virus, hepatitis, etc. Injury or infection of eyes, ears, and other vulnerable tissues. Injury or illness resulting from being lost and separated from the group. Injury that results from unanticipated conditions or "Acts of God". To minimize the risk of injury, the staff needs to be aware of any existing physical, mental, or emotional conditions the participant may have that could in any negative way affect, or be affected by, participation in the activity. Too assume full responsibility for any risks or loss, or personal injury, including death and damage to property that may be sustained by the participant or parent as a result of training for, or traveling to or from, or participating in any manner in the summer program; and To release, waive, hold harmless, discharge it from any and all liability, and agree not to sue the person or entity responsible for administering the summer program, Northland College, or its trustees, officers, employees, agents, participants, staff, volunteers, subcontractors and any other persons involved in or affiliated with the Summer Program, as well as their successors and assigns (hereinafter referred to as “released persons”) from all claims, losses, damages, demands, expenses, attorney fees, breach of statutory duty or duty of care, warranty, strict liability, and causes of action whatsoever, present or future, whether known, anticipated, or unanticipated, and resulting from or arising out of, or incident to, the undersigned's or the undersigned’s guardian participation in or traveling to or from the summer program, or from the facilities and equipment in place or as a result of, or incident to, the summer program, or otherwise following staff instructions anywhere. This release is intended to be the most expansive release allowed under the applicable law. If any part of this release is deemed invalid, illegal or unenforceable in any respect, the enforceability of the remainder of this release and agreement will continue in full force and effect. I understand that by agreeing to this clause I am releasing claims and giving up substantial rights, including the right to sue. Understanding and Assumption of Risk* I understand and have read the above assumption of risk, waiver of liability, and agreement not to sue. AcknowledgementAgreement of Participant*By entering the participants full name in this field you are agreeing that the participant accept the conditions of Northland College's 1) Expectation of Conduct; 2) Student Zero Tolerance Agreement; and 3) Assumption of Risk, Waiver of Liability, and Agreement not to Sue. Name Agreement of Parent or Guardian*By entering your full name in this field you are agreeing that you have read and accept the conditions of Northland College's 1) Expectation of Conduct; 2) Student Zero Tolerance Agreement; and 3) Assumption of Risk, Waiver of Liability, and Agreement not to Sue. Name Date* Complete Step 3Clicking "submit" will send your release and waiver form to us and take you to step 4, the climbing wall waiver.EmailThis field is for validation purposes and should be left unchanged.