First Name *
Email Address *
Step 1 of 2
I hereby give my consent for (applicant) to participate in the academic and recreational activities that are part of this program. The undersigned applicant and parent / guardian understands that the applicant will be engaging in some physical activity during the program which contains an inherent risk of physical injury and the undersigned assumes the risk, indemnifies, and releases Leaders for Life, Inc., its officers, directors, agents, and employees from any and all liability for personal injury and property damage arising out of the applicant’s participation in the summer camp program.
If at any time it is necessary for the applicant to receive outside or professional medical attention, I hereby give my consent to the Leaders for Life, Inc. staff to select and secure such medical services as are deemed necessary. Our insurance company, address, policy, and health information of the applicant are provided below in case of an accident and I have signed verifying that the applicant has insurance coverage.
Leaders for Life, Inc. is a non-profit organization founded by a native resident of the city of Newark
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