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* 1. Student First Name

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* 2. Student Last Name

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* 4. Date of Birth

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* 5. Grade as of September 2021

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* 7. Address

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* 8. Cell Phone

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* 9. Email Address

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* 10. School District

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* 11. M/F?

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* 13. Insurance Information of Student

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* 14. Family Physician

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* 15. Date of Last Physical

Date

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* 16. Please list any allergies/medications below.

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* 17. Medical and Consent for Treatment
To the best of my knowledge ________ is in excellent physical condition and has my permission to participate in Project C.H.U.C.K Summer 2021.

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* 18. Promise
I agree to take responsibility as a player to read my assigned book, attend study hall and to review and follow all Project C.H.U.C.K. rules.

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* 19. Statement of Parental Responsibilities and Release
To participate in Project C.H.U.C.K. a Best of the Batch volunteer in consideration of this services to be performed by its sponsors, officers, and staff, I do hereby assume all the risks and hazards, incidental to the conduct of the activities, and I do further hereby release, absolve, indemnify, and hold harmless Project C.H.U.C.K., operated and sponsored by Best of the Batch, its sponsors, officers, staff and volunteers of and from all manner of action and actions, cause or causes of action, suits, debts, and sums of money, claims of demands, whatsoever, in law or equity, arising out of or pursuant to the conduct of the activities. I am fully aware of the risks inherent to this activity and should not participate or allow my child to participate unless medically able. I assume all risks associated with this activity. I also agree that photographs, recordings, or any other record may be used for the promotion of promoting programs operated or sponsored by Best of the Batch. In case of accident or illness, I authorize a representative of Project C.H.U.C.K. to obtain immediate care deemed necessary by licensed medical personnel. I hereby take responsibility for the above information and it is accurate to the best of my knowledge. 
By signing means you have read and understand the rules and regulations given by Best of the Batch Foundation or Project C.H.U.C.K. Any violations of these rules will result in immediate dismissal from the program. I have read and fully understand that these terms are contractual and not a mere recital and sign it voluntarily and hereby take responsibility for the above information and release Best of the Batch Foundation of any injuries and obligations.

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* 20. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Best of the Batch Foundation and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Best of the Batch may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Best of the Batch employees, volunteers, and program participants and their families.

 I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at Best of the Batch or participation in Best of the Batch programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Best of the Batch Foundation, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the foundation, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Best of the Batch program.

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