I hereby give consent for photographs and/or motion pictures of my child to be used for any of the following purposes: HASDC publicity, public service announcements on television or the internet, publicity with supporting agencies, scholarship awards, camp promotion or any other agency-approved and supported activity.
I, First Name Last Name , am the parent/ legal guardian of a camper who will travel to and attend Camp Firefly (hereinafter the Camp), sponsored by the Hemophilia Association of San Diego County. I understand that the activities involved in Camp may pose the risk of harm or injury. On my own behalf, and on behalf of my child or ward, I hereby freely and expressly consent to release, discharge, indemnify and hold harmless the Hemophilia Association of San Diego County, and their respective agents, employees, and representatives from any damage, claims, loss, or injury sustained by me or my child/ward while traveling to or from the Camp, while attending or participating in any activities at Camp, or any other trips or activities sponsored by the Hemophilia Association of San Diego County. This release includes within its scope any damage, loss or injury sustained as a result of any ordinary negligence, whether active or passive on the part of the Hemophilia Association of San Diego County, or any of their respective agents, employees or representatives.As the parent/guardian of the camper, I hereby give my consent to any medical treatment, including any examination, X-ray, anesthetic, medical or surgical diagnosis or treatment, or hospital care to be rendered to me or my child/ward under the general or special provisions of the Medical Practice Act, or to consent to any dental treatment, including any examination, X-ray, anesthetic, dental or surgical diagnosis or treatment, or hospital care to be rendered to me or my child/ward by a dentist licensed under the provisions of the Dental Practice Act. This authorization shall be effective while I or my child/ward is en-route to or from Camp, or involved or participating in any program or activity of Camp, or under the supervision of any personnel associated with the Camp, regardless of the location where treatment or care is rendered, unless earlier revoked by me in writing and delivered to the Camp Director.The foregoing release is to be construed in accordance with the laws of the State of California. It is intended to release claims, which are not yet known. Accordingly, I hereby waive, on my own behalf, and on behalf of my child/ward, the provisions of California Civil Code §1542, which provides:“A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.”I have read and understood this Release and Authorization and the information I have given is true and correct.