Liability Waiver 

I, the undersigned parent or legal guardian, hereby give permission for  my child to participate in the ELEVATE Bridgeport program and the related field trips and off-campus activities of ELEVATE Bridgeport during the school year. Also, I give permission for ELEVATE Bridgeport staff to access and share with collaborative community partners, my child’s school records including but not limited to: grades, attendance, disciplinary action and standardized test scores. These records are to be released for statistical purposes, publishable and presentable research, program evaluation, and to assist in the giving of awards. Your child's name will always remain anonymous and will be a part of data collected school-wide, so individual data will no be shared. 


I also give ELEVATE permission to use participant's image for press releases and advertising.


I acknowledge and am aware that participation in ELEVATE Bridgeport involves activities that can be physically, mentally, and emotionally demanding. Participation necessarily involves travel in motor vehicles. Participation may include activities involving light physical exertion including, but not limited to: hiking, swimming, camping, and recreational team sports. I understand that participation in ELEVATE Bridgeport  activities involves risk of physical injury. I further release the ELEVATE organization, staff members, directors, officers, and/or volunteers from all actions, causes of action, liability, claims and demands upon for any injury, damage, loss, or suffering arising from or related to the aforementioned person’s participation in the above activities. (If the undersigned DOES NOT WANT to give ELEVATE access to participant’s school records, he/she should initial here: _____________ )


In addition, I take full responsibility for all expenses incurred for any accidents or injuries including medical care and related transportation costs and hold the ELEVATE organization, staff members, directors, officers, and/or volunteers harmless from any costs incurred therein.


In the event of any emergency, I understand every effort will be made to contact me (and if I’m not available, the alternative person listed below) where medical treatment is required. In the event I cannot be reached, I further authorize the ELEVATE staff or volunteer to render, transport to, or otherwise obtain emergency medical care (including hospitalization, anesthesia, surgery or injections of medication) or the services of a licensed physician or dentist for the above-named person.

Do your child have any allergies?
Has your child been diagnosed with any medical condition, illness, or injury?

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