Student Liability Form

I understand that by signing below, I give my child consent to participate in the Splash! program operating under the auspices of Brandeis University. I further understand that I give my child permission to travel within the University campus. I grant the representatives of the University permission to secure emergency medical attention for my child should the need arise while participating in the program.

I further understand that by signing below, I am releasing Education for Students by Students, Brandeis University, and their trustees, employees and agents from any and all liability of any kind and nature arising from my child’s participation in this program.

I understand and agree that Brandeis University and Education for Students by Students is not responsible for my child outside of the program’s hours of operation: 11 am to 5 pm on Saturday, November 12th, 2016.

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    Emergency Contact Information

    Please list two emergency contacts for the student.
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    Parent Signature

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