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1200 North Quaker Lane
Alexandria, Virginia 22302 

Informed Consent and Waiver of Liability and Release

Residential Program

In consideration of and in order for my child(ren) (identified below) and I to be permitted to enter and/or use the property of Episcopal High School (the “School”) and for my child to participate in the (the “Program”) from (see below) the undersigned Parent(s) and/or Legal Guardian(s) (“Parent”) hereby agree to the terms and conditions expressed in this Informed Consent and Waiver of Liability and Release.

 

Parent represents that they have the custodial authority to execute this Informed Consent and Waiver of Liability and Release on behalf of their child(ren). 

 

Parent understands and acknowledgesthat their child(ren) will participate in the Program and that the Program consists of their child(ren) residing in one of the dorms on the School’s property. Parent acknowledges that information about the Program has been provided to them. Parent acknowledges that they have full knowledge of the nature and extent of all risks associated with the Program. Parent expressly agrees and promises to accept and assume all of the risks associated with their and their child(ren)’s entrance and/or use of the School’s property and their child(ren)'s participation in the Program.     

 

Parent understands and acknowledges that the School makes no warranty or representation, express or implied as to any matter whatsoever, including the condition of its equipment or facilities, their merchantability, design, certification, or fitness for any particular purpose. Parent also understands and acknowledges that the School is not the manufacturer of the equipment. Parent accepts the School’s equipment, facilities, and any Program equipment “as is.” 

 

Parent acknowledges and understands that they and their child(ren) are required to follow all rules set by the School, the Program, and their employees. Parent further acknowledges that they have been given the opportunity to ask questions of the School through the host of the Program prior to granting this consent.  

 

In order for my child(ren) to be permitted to swim or participate in any water-based activity while participating in this Program on the School’s property, Parent hereby understands and acknowledges that the decision for their child(ren) to swim or participate in a water-based activity is purely voluntary, and Parent expressly agrees and promises to accept and assume all of the risk associated with their child(ren) swimming or participating in any water-based activity. By signing below, Parent agrees that they have full knowledge of the nature and extent of all risks associated with swimming and any water-based activity, including but not limited to:

 

-  All manner of injury, including but not limited to death and/or paralysis due to drowning, serious bodily injury or head injury from falling on/off of a pool deck or dock, and death or serious injury due to holding one’s breath for prolonged periods of time underwater (a phenomenon known as shallow water blackout).

 

Parent further acknowledges that the above list is not inclusive of all the possible risks associated with their child(ren) swimming or participating in a water-based activity while participating in this Program, and that Parent knowingly accepts these additional risks. Parent understands and acknowledges that their child(ren) will not undergo a swim test administered by the School prior to swimming or participating in a water-based activity. Furthermore, Parent understands and acknowledges that there may be no lifeguards on duty or adult supervision when child(ren) is swimming or participating in a water-based activity, which means their child(ren) is swimming and participating at their own risk.

 

Parent understands and acknowledges that their child(ren) is required to follow all rules of any swimming and/or water-based activity set by the Program and any additional rules set by the School. 

 

By signing below, Parent acknowledges that there are risks associated with their child(ren) swimming or participating in any water-based activity while participating in this Program and the full nature and extent of these risks, inherent or otherwise, whether or not described above, and assume responsibility for the risks and my decision making

 

Parent fully and voluntarily releases and holds harmless, to the maximum extent permitted by law, the School and all of its officers, directors, administrators, employees, students, and guests (the “Released Parties”) from any responsibility for any and all losses, costs, expenses, attorneys’ fees, and damages of whatever kind or nature, for any injury to Parent or their child(ren) (including, without limitation, any injuries arising out of or related to potential exposure, infection, and/or spread of COVID-19, its variants, and other communicable diseases) based on Parent or their child(ren)’s entrance and/or use of the School’s property, their child(ren)’s residing in one of the School’s dorm, their child(ren)’s swimming or participating in any water-based activity, and their child(ren)’s participation in the Program, unless such injury is caused solely by the intentional misconduct of a Released Party, or by an obvious and defective condition of the School’s property or any transportation provided by the School and which the School knew about and failed to correct.

 

Parent shall fully indemnify the School and save it harmless from and against any and all claims, actions, damages, liability, and expenses arising from any occurrence, accident, or injury incurred during the Program and which is the result of a negligent or intentional act or omission on their or their child(ren)’s part. In the event the School is notified of any claim or made party to any litigation commenced against Parent or their child(ren), Parent shall protect and hold the School harmless and shall pay all costs, expenses, and reasonable attorneys’ fees incurred or paid by the School in connection with such claim or litigation. 

 

By signing this Informed Consent and Waiver of Liability and Release, the undersigned acknowledges that there are risks associated with their and their child(ren)’s entrance and/or use of the School’s property, their child(ren)’s residing in one of the School’s dorm, their child(ren)’s swimming or participating in any water-based activity, and their child(ren)’s participation in the Program and the full nature and extent of these risks, inherent or otherwise, whether or not described above,and assume responsibility for the risks and their and their child(ren)’s decision making and have read this Informed Consent and Waiver of Liability and Release and fully understand its contents and significance.

This Informed Consent and Waiver of Liability and Release shall be governed by the laws of the Commonwealth of Virginia. In the event any portion of this document is adjudged unenforceable, the remainder shall remain in full force and effect. 

By typing/signing my name on this electronic record, I am agreeing to the information above. I agree and authorize Episcopal High School to rely on my electronic signature and understand and acknowledge that it has a legally binding effect.

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Summer Program
Please Select the Residential Program you are attending? *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Summer Program
Please Select the Residential Program you are attending? *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Summer Program
Please Select the Residential Program you are attending? *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Summer Program
Please Select the Residential Program you are attending? *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Summer Program
Please Select the Residential Program you are attending? *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Summer Program
Please Select the Residential Program you are attending? *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Summer Program
Please Select the Residential Program you are attending? *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Summer Program
Please Select the Residential Program you are attending? *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Summer Program
Please Select the Residential Program you are attending? *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Summer Program
Please Select the Residential Program you are attending? *
Parent or Guardian's Email Address

Email*

Confirm Email*
Episcopal High School would like to contact you in connection with summer programming offered by the School, including invitations to school-sponsored events and programs. If you consent to allow such communication from Episcopal High School, please check the box.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Summer Program
Please Select the Residential Program you are attending? *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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