KCK Club Permission Slip Form
We, the undersigned parent and student, request permission to participate in the following activity in conjunction with WS/FCS, and Kernersville Cares for Kids (KCK).
Description of Activities: During and After School Youth Drug, Alcohol, and Tobacco Prevention Club: A club designed for middle and high school students to build leadership skills and make a positive impact on their school environment through the promotion of anti-abuse and use messages and activities, including travel to program activities. Annual training and activities will be offered as a part of the program. Participation in these events is highly encouraged for members.
Transportation: Transportation to and from club meetings will be the responsibility of the student and guardians. Transportation for special programs/trainings may be provided through WSFCS if predetermined for the event/activity.
Risk of Injury: Even with faculty supervision, the use of appropriate equipment and adherence to the rules for the various activities injuries are still a possibility, and, on rare occasions, injuries may include or result in total disability, paralysis or even death. It is impossible to eliminate this risk.
Voluntary Participation: We understand the student is not required to participate in this activity, but has requested to do so, and we voluntarily, without force, coercion or duress, agree to allow the student to participate in this activity of the student’s voluntary free will.
Participation Rules: I agree, without exception, that I shall follow the rules for this activity as explained by the organizer. These rules are designed to ensure the safety of all participants. Failure to follow the rules may result in injury. However, following the rules is not a guarantee that I will not suffer injury while participating in this activity.
Assumption of Risk and Release of Liability: By executing this release, I hereby assume any and all risk of injury associated with the program described above. I agree to release, hold harmless and indemnify the Winston-Salem/Forsyth County Board of Education, and Kernersville Cares for Kids, its members, agents, representatives and employees, from and against any and all claims, suits or causes of action I may have or incur arising from or out of an injury I may suffer while participating in the activity described herein above other than an injury caused by willful or gross negligence or intentional wrongdoing by the WS/FCS, Kernersville Cares for Kids, its agents or employees.