I hereby authorize the staff, volunteers, and agents at BeachSports / PCH Skate Camps to administer an EpiPen® to my child if he or she has known exposure and/or a severe allergic reaction. I agree to release, indemnify, and hold harmless BeachSports, PCH Skate Camp, Sports Camp Management, LLC, and any of its staff, volunteers, or agents from lawsuit, claim, expense, demand, or action against them for administering the EpiPen® provided they administer the EpiPen® prescribed specifically for my child. I am aware that the injection probably will be administered by a staff member, volunteer, or agent who is not a healthcare professional. I understand that I will always be notified as quickly as possible anytime an EpiPen® has been administered to my child.
Furthermore, BeachSports/PCH Skate Camp and any of its staff, volunteers, or agents are not responsible for the damage, loss or theft of the EpiPen while in their possession.
The undersigned parent or guardian of Participant hereby covenants, warrants, represents and agrees that he or she is executing this Agreement on behalf of, and as an agent for, any other individual who may be a parent or guardian of Participant, and that by executing this Agreement, the undersigned is binding himself/herself, Participant, and any other parent or guardian of Participant and all of their heirs, executors, personal representatives, assigns and estates to this Release.
Today's Date: December 9, 2022