Permission, Insurance and Responsibility Form

The undersigned parents or legal guardians (the “Parents”) are desirous of having the Student participate in a travel excursion to Wasatch Mountains and surrounding environs for the period of time September 8, 2015 to May 25, 2016 the (“Excursion”), to be conducted and directed by Chris Watkins, Chris Todd, Ingrid Knowles and Meg Hungerford (the “Faculty Advisors”), who are faculty at The Waterford School (“Waterford”). As used herein the term “Waterford” shall refer to and include the Waterford Institute. To that end, the Parents and Student hereby acknowledge and agree as follows:

1. Permission. The Parents hereby give their consent and permission for the Student to participate in the Excursion, and the Parents and the Student assume all risks inherent in the Excursion including but not limited to the risk of travel, accident, personal injury, loss or damage to property, sickness, disease, catastrophe, and potential political, military or terrorist activities (the “Inherent Risks”). The Parents and the Student accept full responsibility for procuring passports, visas and other documentation necessary for the Excursion and the Parents hereby undertake to pay directly or reimburse Waterford for all costs and expenses for the student’s participation in the Excursion.

2. Release. The parents hereby relieve, release and discharge the Faculty Advisors and Waterford from, and agree to hold the Faculty Advisors and Waterford harmless from and against all claims, demands, causes of action, loss, damage, judgments, negligence, costs, expenses, obligations and liabilities of any kind relating to or arising about of the Excursion (including the Inherent Risks). Moreover, the Parents and Student agree that any exposure and liability of Waterford, if any, shall be limited to the coverage’s and benefits provided under Waterford’s policy of liability insurance. Without limiting the foregoing, neither the Faculty Advisors nor Waterford shall be responsible for the acts of any third parties, including all providers of transportation, lodging, meals, baggage handling, tour-guide services, medical services, or other services in any way related to the Excursion.

3. Medical Insurance and Treatments. Parents assume full responsibility for arranging such insurance in connection with the Excursion, and the Parents assume full responsibility for arranging such insurance if desired. In order to facilitate prompt medical treatment of the Student if the need arises, the Parents hereby consent to any necessary medical treatment and appoint the Faculty Advisors as their due and lawful attorneys-in-fact with full authority to arrange, consent, or give permission for any medical treatment reasonably required by the Student during the Excursion.

4. Conduct and Discipline. The Student shall abide by Waterford’s standard policies and rules of personal conduct during the Excursion. In the event of any substantial breach of said rules or policies (including transporting or abusing drugs, or alcohol) or engaging in any illegal or disruptive conduct, the Faculty Advisors shall have the right, upon telephonic notice to the Parents, to send the Student home at the Student’s own expense, without escort and without refund of moneys paid or payable for the Excursion.

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