For the 2020-2021 school year, Lake County School District (LCSD) is partnering with community organizations to provide out of school time offerings for LCSD students, which include after school programming (Project Dream) and Friday extended learning programs (Panther Days) (collectively, the “Out of School Time Program” or “Program”). The goal of these programs is to provide diverse, high-quality, out of school time offerings for youth. Programming will include academic intervention, social-emotional learning, arts, physical activities, sciences, and outdoor learning and pursuits. Some activities may include additional risks, such as outdoor programming. This Participation Agreement and Release must be signed and returned to LCSD before a student may participate in the LCSD Out of School Time Programs.
PARTICIPATION CONSENT: I consent to the above-named student’s (Student) participation in the Program with LCSD and Community Partner (as defined below).
COMMUNITY PARTNER CONSENT: I acknowledge and agree that Program activities may be provided by LCSD and/or one or more of the community partners (BOOST member organizations) listed in the Out of School Time Registration Form (each a “Community Partner”). I consent to Student’s participation in each Community Partner’s activities under the supervision of LCSD and/or such Community Partner.
EDUCATION RECORDS RELEASE: I authorize LCSD to disclose Student’s education records to each Community Partner to the extent necessary for Student’s participation in the Program. I understand that this consent to disclose Student’s education records is in effect from the date signed below until the end of the current school year. I understand and acknowledge that I may revoke this consent in writing at any time, but that such revocation may result in Student not being able to participate in the Program.
TRANSPORTATION CONSENT: I understand that LCSD and/or Community Partner may provide transportation to the Student to travel to-and-from activities during the Program. I consent to LCSD and Community Partner transporting Student.
HEALTH/MEDICAL TREATMENT CONSENT: I confirm that Student is in good health and that Student’s participation in the Program does not pose a hazard to Student’s health or the health of others. I hereby give my consent to LCSD and/or Community Partner to seek emergency medical treatment in a medical facility by a physician or other licensed health care provider should the Student’s condition require it in my absence. Should an emergency arise, I understand that a reasonable effort will be made, time and conditions permitting, to locate me before any action will be taken. I fully understand that neither LCSD nor Community Partner provides accident or health insurance coverage for the Student while he/she participates in the Program. I fully understand and acknowledge that it is my responsibility to provide insurance coverage for the Student. I assume financial responsibility Student’s emergency transport to or treatment at a healthcare facility.
STUDENT HANDBOOK/COMMUNITY PARTNER POLICIES: I certify that the Student and I have been given a copy of the LCSD Conduct Code and that we have read and agree to comply with the terms thereof during participation in the Program. I understand that Student and I may receive policies, rules, and regulations from each Community Partner regarding Program activities. We agree to comply with the terms thereof during participation in the Program.
ASSUMPTION OF RISK, RELEASE OF LIABILITY AND WAIVER OF CLAIMS:
The Program may take place away from LCSD property and will involve activities beyond the scope of traditional school functions conducted at LCSD. As the undersigned parent or legal guardian of the Student, I understand and hereby acknowledge that participation of Student in any Program activities involve INHERENT RISKS AND HAZARDS, including without limitation, dehydration, heat stroke, heat cramps, suffocation, slips, falls, rope burns, pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, paraplegia, quadriplegia, or other serious permanent physical impairment and even death, as well as minor or catastrophic property damage and loss. A complete listing of inherent and other risks is not possible. There also are risks that cannot be anticipated.

I consent to Student’s participation in the Program and ON BEHALF OF STUDENT AND MYSELF, I FREELY ACCEPT AND FULLY ASSUME ALL COSTS, RISKS, DANGERS, AND HAZARDS of Student’s participation in the Program.

I understand that LCSD and Community Partners cannot accept and will not have any responsibility for Student’s or any third party’s intentional or negligent acts or omissions occurring during Student’s participation in the Program.

In consideration of LCSD and Community Partners allowing Student to participate in the Program, on behalf of Student and myself, I hereby expressly agree as follows:

1. TO WAIVE ANY AND ALL CLAIMS whether known or unknown, now existing or arising at any time in the future that I have myself or on Student’s behalf against LCSD, a Community Partner, or any of their successors, assigns, board members, shareholders, employees, representatives, agents and volunteers (“Released Parties”), arising directly or indirectly from Student’s participation in the Program.
2. TO RELEASE AND HOLD HARMLESS THE RELEASED PARTIES from any and all liability for any claims, loss, damage, injury or expense that Student may suffer as a result of, but not limited to, Student’s participation in the Program.
3. TO INDEMNIFY THE RELEASED PARTIES for any and all expenses incurred, including without limitation, attorneys’ fees and costs, as the result of any claim brought against any of the Released Parties by anyone relating in any way to Student’s acts or omissions or as a result of injury sustained by Student while participating in the Program.
4. THAT THIS ASSUMPTION OF RISK AND WAIVER OF LIABILITY shall be effective and binding upon my heirs, next of kin, executors, administrators and assigns, in the event of my death or incapacity.
5. THAT THE TERMS OF THIS ASSUMPTION OF RISK AND WAIVER OF LIABILITY shall apply, and have priority over any previous agreement or written agreement, representation, terms or conditions to the contrary, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THE ABOVE, TO CONSULT WITH AN ATTORNEY TO THE EXTENT I HAVE DEEMED IT NECESSARY, BEEN GIVEN THE OPPORTUNITY TO ASK QUESTIONS, CONSIDER ITS EFFECTS, UNDERSTAND THIS ENTIRE DOCUMENT AND AGREE TO BE BOUND BY ITS TERMS. I ACKNOWLEDGE THAT PARTICIPATION BY STUDENT IN THE Program IS VOLUNTARY. I AM AWARE THAT BY SIGNING THIS RELEASE I AM WAIVING CERTAIN LEGAL RIGHTS THAT I MAY HAVE ON BEHALF OF STUDENT AND/OR MYSELF TO BRING LEGAL ACTION AGAINST THE RELEASED PARTIES. I SIGN IT KNOWINGLY AND VOLUNTARILY.