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Iowa City Emergency Services High School Camp
Parental Consent & Media Waiver
9-12th Grades
1 of 2
I understand that my child will be attending and participating in activities as part of the Iowa
City Emergency Services High School Camp. I understand the Camp may involve physical
activities that may be difficult or strenuous. I understand and accept any risk associated with
my child attending the Camp 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 Camp, 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 Camp.
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 Emergency Services High School Camp (9-12th Grades) 2019 Schedule
July 29-30, 2019, 8:00-4:00 daily
Meet at Iowa City Fire Station #4, 2008 N. Dubuque Road, Iowa City, IA 52240
THIS RELEASE IS VALID FOR A MAXIMUM OF ONE YEAR FROM DATE SIGNED
Iowa City Emergency Services High School Camp
Parental Consent & Media Waiver
9-12th Grades
2 of 2
______________________________(Student) desires to participate in the Iowa City Emergency
Services High School Camp to be conducted by the Iowa City Fire Department / Iowa City Police
Department / Johnson County Ambulance Service / University of Iowa Police Department /
Johnson County Emergency Management for youth with an interest in Emergency Services
career path. In an attempt to promote future participation in the Iowa City Emergency Services
Camp(s), local media may be photographing/recording 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