I hereby request that JSerra Catholic High School ("JSerra") permit my son/daughter identified above to participate in the school's Summer School program. I hereby knowingly and voluntarily assume any and all such risks. Moreover, for valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I, individually and on behalf of my minor student, hereby knowingly and voluntarily release, acquit, and discharge JSerra, and each of its officers, directors, employees, agents, volunteers, and representatives, of and from any and all liability, damages, costs, claims, demands and/or causes of action relating to or arising from such participation.
I further authorize JSerra personnel, as agent for the undersigned, to consent on behalf of my son/daughter to any medical treatment (including but not limited to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital care) which is deemed advisable by the physician, nurse or other health care practitioner present at or in connection with Summer School program.
By signing your name below, you grant permission for JSerra Catholic High School to reproduce through printed, audio, visual, or electronic means activities in which your student has participated in the Summer School Program. You, as a parent or guardian, of the above named student fully authorize and grant JSerra and its authorized representatives, the right to print, photograph, record, and edit as desired the biographical information, name, image, likeness, and/or voice of the above named student on audio, video, film, slide, or any other electronic and printed formats.
USE OF STUDENT INFORMATION
We, the undersigned, hereby authorize JSerra to use our student's name, photograph, and other information in school publications and on the school website.