I, the parent/guardian of the minor participant listed on this registration, for ourselves, our heirs, executors and administrators, hereby release, waive, acquit and forever discharge the Spanish American Center, their representatives, successors, insurers, assigns or any other person or entity associated with any of the above organizations such as staff, directors or volunteers, from all liability, claims, demands, or causes of action for any and all loss, damage, injury or death and any claim of damages resulting from use of facilities owned or controlled by the above organizations, or participation in activities of said organizations either at or away from Spanish American Center.
Medical Treatment
I give permission to the Spanish American Center to seek emergency medical treatment for my minor participant if I cannot be reached. I will be responsible for any/all costs of medical attention and treatment.
Data Collection
I give my permission to the Spanish American Center, to collect information via on-line or written surveys, questionnaires, interviews, and focus groups from the minor participant listed on this registration. Any and all information received will be kept strictly confidential. Data gathered through these means will be summarized in the aggregate and will exclude all references to any individual responses. The aggregated results of these analyses may be shared with the Spanish American Center staff, funders, and other community stakeholders to evidence program effectiveness and/or impact on our program.
Data Sharing
I understand that the Spanish American Center may utilize information about the minor participant listed on this registration for research purposes and/or to evaluate the program’s effectiveness. Information that will be utilized may include the information provided on this registration form, information provided by the minor participant’s school or school district, and other information collected by the Spanish American Center including data collected via surveys or questionnaires. All information obtained by the Spanish American Center will be kept confidential.
School Information
I give my permission to the Spanish American Center, along with the Leominster School District to exchange information regarding the minor child listed on this application. The purpose of the exchange is to help both organizations do a better job of helping the participant be successful in school, in the Spanish American Center, and in life. This release is valid for one year and may be revoked at any time by contacting the Leominster School District or the Spanish American Center in writing.
Technology
As a participant of the Spanish American Center, your child will have access to the Internet. While precautions are being taken, it is possible who s/he may access inappropriate sites. The Spanish American Center will have rules and consequences for such behavior; however we will not be responsible for the consequences of such access.
Field Trips Permission
I give full permission for my child in my care to be transported from the Spanish American Center to and from any field trips during program hours. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the Spanish American Center to transport my child to a Hospital or Medical Facility nearby, and to secure for my child necessary medical treatment. I understand that I will assume full responsibility for any accidents incurred, thereby releasing the Spanish American Center (their Staff, Volunteers, and Directors) of all liabilities including the event of your child’s or charge’s injury, illness, or death while participating in a Spanish American Center outing.
Field Trips Permission
I give full permission for my child in my care to be transported from the Spanish American Center to and from any field trips during program hours. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the Spanish American Center to transport my child to a Hospital or Medical Facility nearby, and to secure for my child necessary medical treatment. I understand that I will assume full responsibility for any accidents incurred, thereby releasing the Spanish American Center (their Staff, Volunteers, and Directors) of all liabilities including the event of your child’s or charge’s injury, illness, or death while participating in a Spanish American Center outing.
