DCSSA Waiver and Liability Form (required for participation)

Please fill out the form below, being sure to check the box provided below the waiver indicating that you agree to the terms noted in the waiver, and then give the current date. Then click SUBMIT to submit the form. Note that submitting the completed form electronically is equivalent to signing the form digitally and is legally binding. If you have more than one child attending, you must fill out this form for each child.

Camper Name

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Emergency Parent/Guardian Phone Number (cell preferred if possible)

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Waiver of Liability and Release of Claims - Please read the following waiver carefully and check the box below to confirm you voluntarily agree to all the terms outlined below in the waiver.

: I, hereby agree to release, indemnify, and hold harmless the Inspired Teaching Demonstration School ("School") and its affiliates, directors, officers, employees, and volunteers from any and all claims, demands, causes of action, losses, damages, costs, or expenses, including but not limited to attorney's fees, arising out of or in connection with my child's attendance at the DC Summer STEM Academy (DCSSA) held at the School premises from July 24-July 28, 2023. I understand and acknowledge that the DC Summer STEM Academy is an independent summer camp program and is not affiliated with the School. The School is solely providing its facilities and equipment, including computers, to the DC Summer STEM Academy for their use during the summer camp. By signing this waiver, I explicitly acknowledge and agree to the following: 1. Assumption of Risks: I understand that there are inherent risks associated with my child's participation in the DC Summer STEM Academy, including but not limited to the use of computers, participation in various activities, and interactions with other participants. I acknowledge that the School and its staff have taken reasonable measures to minimize such risks, but I understand that accidents, injuries, or damages may still occur despite these precautions. 2. Waiver of Liability: I hereby waive any and all claims or causes of action that I, my child, or our representatives may have against the School arising out of or in connection with my child's attendance at the DC Summer STEM Academy. This includes but is not limited to, claims for personal injury, property damage, or any other harm that may arise during the course of the summer camp. 3. Indemnification: I agree to indemnify and hold harmless the School and its affiliates, directors, officers, employees, and volunteers from any and all claims, demands, actions, suits, or judgments, including attorney's fees and legal costs, that may arise from any act, omission, or negligence on the part of my child or myself during my child's participation in the DC Summer STEM Academy. 4. Responsibility for Damages: I understand that the DC Summer STEM Academy will be utilizing the School's computers during the summer camp. In the event of any damage caused to the School's property, including but not limited to computers, by my child or myself, I agree that I am solely responsible for any repair, replacement, or compensation necessary to rectify the damage. 5. Medical Emergencies: In the event of a medical emergency or injury to my child during the DC Summer STEM Academy, I authorize the DC Summer STEM Academy and its staff to obtain emergency medical treatment and care on behalf of my child. I understand that the DC Summer STEM Academy will make reasonable efforts to contact me or the emergency contact listed on the registration form, but I acknowledge that the DC Summer STEM Academy cannot be held responsible for any delay or inability to reach me in a timely manner. 6. Dropoff and Pickup: I affirm that DC Summer STEM Academy is NOT responsible for the supervision and care of my child(ren) outside of camp hours (9:30 am - 2 pm) each day. I understand that after 2 pm, my child will not be able to wait inside the school building are on the campus, and the DC Summer STEM Academy cannot be responsible for the child before 9:30 am or after 2 pm. Clicl the box below to indicate you have read the waiver and agreed to all its terms.

I affirm that I have read this waiver of liability and release of claims in its entirety, and I understand and voluntarily accept its terms and conditions. I acknowledge that this waiver shall be binding upon me, my child, our heirs, executors, representatives, and assigns.

Today's Date

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