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School Year 2018/2019 Child Information Card

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Address
State
State
Address
State
State

Names(s) of Person(s) Other Than Parent To Whom Child Can Be Released

I hereby give permission to CEDAR CREST ACADEMY to secure emergency medical and/or emergency surgical treatment for the above named minor child while in care. 

Cedar Crest Academy prohibits discrimination or harassment of any person on the basis of race, color, national origin, religion, sex, gender identity, physical or mental disability, ancestry, marital status, age, sexual orientation, or citizenship.

Indemnity and Release Form 

The undersigned is the parent or legal guardian of above-stated child who is a minor.  The undersigned authorizes minor child to voluntarily parƟcipate in camps at Cedar Crest Academy.  In consideraƟon for being permiƩed to participate in camps at Cedar Crest Academy, in the city of Clarkston, the state of Michigan, and country of United State of America, beginning the 25th day of June 2018, I, the undersigned, fully recognizing the dangers and hazards inherent in camps at Cedar Crest Academy, and any related transportaƟon, including personal injury, property damage, or wrongful death, as well as the unknown dangers and hazards which may arise in the course of my minor child’s parƟcipaƟon in camps at Cedar Crest Academy, do hereby voluntarily: 

 Agree, for myself, my heirs and my personal representative, to defend, hold harmless, indemnify, release and forever discharge, to the broadest extent allowed by law, Cedar Crest Academy, its trustees, officers, employees, agents, insurers, successors, assigns, from and against any and all claims,  demands, acƟons, or causes of acƟon on account of any damage to real or personal property or any personal injury or death that may result from my minor child’s participation in camps at Cedar Crest Academy. 

 I have read this release, I understand it fully, I understand that it is legally binding, and I understand that, among other things, I am agreeing to  indemnify Cedar Crest Academy, for injuries, damages or losses I may cause and giving up rights to sue Cedar Crest Academy for injuries, damages or losses  I may incur.