PARENT/GUARDIAN RELEASE OF LIABILITY AND
AUTHORIZATION FOR MEDICAL CARE FOR MINORS
THIS DOCUMENT MUST BE COMPLETED BY THE MINOR'S PARENT OR LEGAL GUARDIAN.
I hereby give my permission for (print minor's name) ______________________________________________________________
to participate in the LOS ANGELES MARITIME INSTITUTE'S TOPSAIL YOUTH PROGRAM aboard the sailing ship(s) SWIFT OF IPSWICH, BILL OF RIGHTS, IRVING JOHNSON, and/or EXY JOHNSON. Date of event:: May22, 2010. Noon-5:00 PM.
I AM AWARE THAT PARTICIPATION IN THE LOS ANGELES MARITIME INSTITUTE'S TOPSAIL & BRIGANTINE YOUTH PROGRAM ABOARD THE SWIFT OF IPSWICH, BILL OF RIGHTS, IRVING JOHNSON, and/or EXY JOHNSON WILL INVOLVE THE SAILING OF THE VESSEL IN HARBORS AND ON THE PACIFIC OCEAN. FURTHER, I AM AWARE THAT THE SAILING OF THIS VESSEL MAY RESULT IN HAZARDOUS ACTIVITY WHICH COULD RESULT IN INJURY OR DEATH. I AM VOLUNTARILY ALLOWING THE MINOR TO PARTICIPATE IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED AND AGREE TO ACCEPT ANY AND ALL RISK OF INJURY OR DEATH AND VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE: ________.
I, the above named minor's parent or guardian, understand that my child must fully cooperate with all paid captain/crew and all volunteer crew members in a respectful manner. It is understood that any child not fulfilling these behavior standards will be sent home at the parents' expense. I have explained these behavior expectations to my child.
I, the above named minor's parent or guardian, knowingly withold all claims against the Los Angeles Maritime Institute, any of it's affiliated organizations or individuals for injury to the minor resulting from negligence, or other acts caused by any employee, agent, volunteer or contractor of vessels SWIFT OF IPSWICH, BILL OF RIGHTS, IRVING JOHNSON and/or EXY JOHNSON its affiliated organizations, its employees and volunteers from all actions, claims and demands that I, the minor, his/her assignees, heirs, distributees, guardians, parents and legal representatives now have or may hereafter have for accident, illness or death resulting from his/her participation in this program.
AUTHORIZATION FOR MEDICAL CARE
Should it be necessary for my child to have medical care while participating in this program. I hereby give LOS ANGELES MARITIME INSTITUTE employees or crew permission to use their judgement in obtaining medical care for the minor, and I give permission to the physician selected by the LOS ANGELES MARITIME INSTITUTE employees or crew to render medical care deemed necessary and appropriate by the physician. I understand that the LOS ANGELES MARITIME INSTITUTE has no insurance covering such medical or hospital costs incurred by the minor and, therefore, any cost incurred by such treatment shall be my sole responsibility.
EMERGENCY CONTACT INFO
Minors Name: _______________________________________ Date of Birth: _________________
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