Informed Consent Agreement and Assumption of Risk
Please read the following carefully.
By typing my name below, I certify that the student being registered has my full permission to participate in the HATS Program activities that will be held at Stetson University in DeLand, Florida.
Assumption of Risk
I understand that my student's participation in the HATS Program activities, which may include a variety of physical activities both indoors and outdoors, could involve risk of physical injury or illness, and I assume the risks associated with these activities, knowing that despite precautions and supervision, not all risks can be prevented. Such related risks could include, but are not limited to:
- Outdoor Activities: Exposure to sun, heat, plants, soil, insects and wildlife;
- Lab Activities: Exposure to preserved biological specimens, dissection procedures, various chemicals, and materials such as latex gloves, gas burners, sharp utensils or tools, and electronic equipment.
Despite efforts made to provide a safe environment there is always a risk of accident or illness. I thereby grant Stetson University and HATS Program personnel/staff full authority to take whatever actions they may consider warranted for my student's health and safety including administering first aid, and to place my student at my own expense, in a medical facility or with a local doctor for emergency medical treatment, and release them from liability for any such decisions or actions. I understand it is my responsibility to provide medical coverage for my student, and/or provide any payments for medical costs that may arise as a result of injuries or illnesses related to HATS Program activities.
Allergies and Medication
Please notify the HATS Program in writing of any allergies, dietary concerns, medical restrictions or other special needs your student may have. In the case of severe food allergies, it is not possible for us to monitor what other studentren bring into class. The HATS Program is NOT responsible for administering medication to students. Consult a pediatrician about altering your student's dosage so that medication can be administered outside of class hours.
Photography and Videography
Stetson University's HATS Program reserves the right to use any photographs, videotaping or other records of the program activities to promote future HATS Program activities. By signing the consent agreement, you are granting the HATS Program and Stetson University permission to use these artifacts in promotional media and for archival purposes.
Student Conduct and Supervision
HATS participants are required to behave in an appropriate manner. Students exhibiting severe or continually disruptive behavior are subject to dismissal with possibility of full or partial tuition forfeiture as determined by the HATS Program director. Stetson University and the HATS Program staff will not be responsible or liable for supervision of students who are dropped off and/or present on campus/HATS premises before or after normal class hours and pick-up/dropoff timeframes, nor for any non-HATS Program activities in which students choose to participate on their own. I also acknowledge that Stetson University and HATS Program staff will not be responsible or liable for damage, theft or loss of any personal property of students or parents including, but not limited to: electronic equipment, phones or money.
Furthermore, in consideration of the opportunity to participate in HATS Program activities, with full knowledge and appreciation of the risks involved, and full understanding of the above and preceding issues/conditions, I hereby release and hold harmless Stetson University, Inc., its faculty, staff, officers, trustees, representatives, students, chaperones and agents from all manner and causes of actions, claims, suits or demands of any nature, including injuries (including death), damages or property loss resulting from my student's participation in the HATS Program and related activities.
Select any of the tabs above to go back and verify your information is accurate before signing and submitting this form.
I certify that the information on this form is complete and correct, and I understand that the submission of false information is grounds for denial of my registration or cancellation of enrollment. I authorize the university to verify the information I have provided. I agree to notify the proper officials of the institution of any changes in the information provided.