Liability Release Form

Medical Emergency: In the event of an injury or medical emergency, I understand that the camp instructor, not Rock 101 New Mexico and camp location, will be responsible for the medical care of all attendees. It will be the camp instructor's responsibility to assess medical needs, obtain and consent to appropriate medical care, transport persons in need of medical care and contact parents or guardians or minors. I release Rock 101 New Mexico and camp location from any and all liability related to medical treatment. In addition, I assume the risk and financial responsibility for any injury resulting from the attendee's participation in all camp events.

Media Consent: I give my consent and permission for the taking of photographs and/or video of my child during the described event and waive and/or assign any and all rights (including copyright) in such media to Rock 101 New Mexico. Rock 101 New Mexico, as the sole owner of such media, shall have exclusive rights to control and determine the use, display, performance, reproduction and dissemination of any such photographs and/or videos.

On this day, intending to be legally bound hereby, the undersigned agrees and does hereby release from liability and to indemnify and hold harmless Rock 101 New Mexico and any of its employees representing or related to Rock 101 NM. This release is for any and all liability for personal injuries and property losses or damage occasioned by, or in connection with any activity or accommodations for this event. The undersigned further agrees to abide by all the rules and regulations promulgated by Rock 101 NM and its employees.

READ THIS DOCUMENT CAREFULLY BEFORE SIGNING.
THIS IS A GENERAL RELEASE AND INDEMNIFICATION OF CLAIMS.


Parent(s) Name *
Parent(s) Name
Student's Name *
Student's Name
Select Session(s) Attending *
Does the Student have an IEP? *
An Individualized Education Program
This allows us to properly plan ahead and make any needed accommodations for group play, rehearsals, and stage time.
List all known food/drink allergies that student should avoid
I give permission for my child to receive appropriate first aid from qualified staff members in the event of accident or injury, and to be transported to the hospital or doctor’s office for needed medical care.
I hereby give permission for images and audio clips of my child, captured during Rock 101 NM Summer Sessions, through video, photo and digital cameras, and audio recordings, to be used solely for the purposes of Rock 101 NM promotional material and publications, and waive any rights of compensation or ownership thereto.
On this day, intending to be legally bound hereby, the undersigned agrees and does hereby release from liability and to indemnify and hold harmless Rock 101 New Mexico and any of its employees representing or related to Rock 101 NM. This release is for any and all liability for personal injuries and property losses or damage occasioned by, or in connection with any activity or accommodations for this event. The undersigned further agrees to abide by all the rules and regulations promulgated by Rock 101 NM and its employees.
Date *
Date

 

ROCK 101 NM Headquarters

9315 Candelaria Rd NE
Albuquerque, NM 87112