HomeMy WebLinkAboutYouth Academy Grades 5 and 6 waiver
Iowa City Police / Fire Academy
Parental Consent & Media Waiver
5th & 6th Grade
1 of 2
I understand that my child will be attending and participating in activities as part of the Iowa
City Police / Fire Youth Academy . I understand the Academy may involve physical activities that
may be difficult or strenuous. I understand and accept any risk associated with my child
attending the Academy and participating in those activities.
I understand that no fee is being charged for my child’s participation, and that I agree to release
and hold harmless, and covenant not to sue the City of Iowa City and its employees, officers,
agents, and volunteers (Released Parties) for any personal injury or property damage I or my
child may suffer. As part of the consideration for providing this Academy, and allowing my child
to participate, I agree to defend and indemnify the Released Parties against any claims
whatsoever that may arise by virtue of my child’s participation in the Academy.
I HAVE READ T HIS DOCUMENT CAREFULLY, AND UNDERSTAND IT. I AM SIGNING THIS FREELY
AND WITHOUT RESERVATION OR CONDITION. (IF YOU HAVE ANY QUESTIONS ABOUT THIS
DOCUMENT DO NOT SIGN IT. CONTACT AN ATTORNEY TO ASSIST YOU)
______________________________ _______ _____________________________________
Parent/Guardian Date Student
Iowa City Police / Fire Academy (7th & 8th Grade) 2015 Schedule
July 6-7, 2015
Start each day at the ICPD Substation, 1067 Hwy 6 E, Iowa City
THIS RELEASE IS VALID FOR A MAXIMUM OF ONE YEAR FROM DATE SIGNED
Iowa City Police / Fire Academy
Parental Consent & Media Waiver
5th & 6th Grade
2 of 2
______________________________(Student) desires to participate in the Johnson County
Public Safety Leadership Academy to be conducted by the Iowa City Police Department / Iowa
City Fire Dept. / Johnson County Ambulance Service for youth with an interest in a Public Safety
career path. In an attempt to promote future participation in the Johnson County Public Safety
Leadership Academy, local media may be photographing or interviewing participants.
PLEASE CHECK THE APPROPRIATE BOX BELOW AND SIGN
YES, I agree to the use of my child’s picture/interview for the current or future events
NO, I do not want my child photographed or interviewed
______________________________________________________________________________
Parent/Guardian Date Student
THIS RELEASE IS VALID FOR A MAXIMUM OF ONE YEAR FROM DATE SIGNED