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I, as parent and/or legal guardian, remain legally responsible for any personal actions taken by
the above named participant.
I agree in behalf of myself, my child named herein, or our heirs, successors and assigns, to hold
harmless and defend Baruya high school, its teachers and officers or representative associated with the
event, from any and all actions, claims, demands, damages, costs, expenses and all consequential
damage arising from or in connection with my child attending the event or in connection with any illness
or injury or cost of medical treatment in connection therewith.
In signing the Parental Consent and Waiver, I am not relying on any oral or written
representation or statements made by the school, its faculty members and officers associated with the
event, to induce me to permit my student to join the film viewing, other than those set out in this
Consent and Waiver.
I am 18 years of age or more and have read and understand the terms of this consent and
waiver, and recognize that it is binding upon me.
Home Address
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Contact Number
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