I have read the completed application, understand the rules of the Boys & Girls Clubs of Rockford and request that my son/ daughter be admitted into membership. For consideration for Boys and Girls Clubs of Rockford admitting my child into member- ship, and other good and valuable consideration, the sufficiency of which I acknowledge, on behalf of myself, any other parent or guardian of my child, I/we agree to indemnify and hold harmless Boys and Girls Clubs of South Oakland County, their agents, members, officers, employees, counselors, and volunteers, from any and all liability, claims, suits, demands, damages, judgments, costs, interests and expenses (including attorney’s fees and all legal costs, any injury and costs of medical services, etc.) arising directly or indirectly from membership in the Boys and Girls Clubs of Rockford or participation or transportation of my child with regard to any activity. I further waive all claims I may have against Boys and Girls Clubs of Rockford, to the fullest extent permitted by law. I also acknowledge I have the authority and ability to sign this Permission Form inclusive with all of its components. In the event any provision of this Form is deemed in- valid, the balance remains in full force and effect. I give my consent for photographs, in which the member may appear to be used in any way the Boys and Girls Clubs of Rockford may use them to support the mission of the Boys and Girls Club.
Authorization to treat a minor: In the event that I cannot be reached in an emergency, I hereby give permission to the Club to allow any physician, medical facility, or other healthcare provider, including paramedic, to provide any emergency medical treatment deemed necessary in the event of injury or illness of my child.