Please read carefully
Release:
I assume all risks and hazards incidental to the conduct of the activities of Gates Recreation Programs and do hereby further release and hold harmless the Town of Gates and the Town of Gates Recreation and Parks Department staff and volunteers. The Town of Gates does not provide medical insurance. The Town of Gates does not provide accident insurance coverage. I give permission for above participant to be given first aid in case of emergency. This includes permission for the participant to be taken to the emergency department of a local hospital and that a licensed physician or hospital staff to administer emergency medical care deemed necessary for the child listed above when normal permission is unavailable. I certify that the child listed above is in good physical health and has no limitations other than those listed on the PROGRAM MEDICAL FORM, which may predispose the child listed above to risk during the program(s). I also fully realize that I must provide proper hospitalization. This health history is correct as far as I know. I have also read and understand the department’s registration information, including its refund policy and procedure. I also understand the department is not responsible for participants’ personal items if lost or stolen.
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