Adventure & Challenge Course Program

Shattuck-St. Mary's has a ropes course on the school campus. Students may occasionally be given the opportunity to use the course with supervision by trained staff. Students typically also participate in at least off-campus group activities each year that include ropes courses, climbing walls, and other types of challenge courses. These activities are also supervised by trained staff. This form is to provide permission for the below named student to participate in various types of Challenge Course / Climbing Structure activities both at Shattuck-St. Mary's and at other locations. Students will always have the choice to not participate in the activity if they are uncomfortable with the activities, but students will not be given the choice to participate if parents/guardians do not provide permission to participate on this form.

Parents/Guardians should discuss each section of this permission form with the student named below.

If information is incorrect in fields you cannot change, or if you have any difficulties completing this form, please contact Ms. Brittany Lau at Brittany.Lau@s-sm.org.
RELEASE OF LIABILITY
• My student and I understand that participating in Challenge Course / Climbing Structure activities while under the influence of a substance would endanger others and oneself.

• My student and I understand that Challenge Course / Climbing activities are, by their nature, physically and emotionally demanding, and that participating in the Shattuck-St. Mary’s program may involve risks such as bending, twisting, lifting, running, jumping, climbing, swinging, increased heart or breath rates, and physical contact with others. My student and I understand that although the Shattuck-St. Mary’s staff will make every reasonable effort to minimize exposure to known risks, not all dangers and hazards can be foreseen (i.e. cuts, bruises, scrapes, fractures, fatalities, etc.). My student and I are aware that certain risks and dangers exist in the activities that are beyond the control of Shattuck-St. Mary’s and their employees. My student and I understand that my student has the right and the responsibility to limit participation in any activity that we believe will compromise my student's safety, and agree to notify a Shattuck-St. Mary’s employee if we have safety concerns. If my student chooses to physically participate in any of the activities, my student and I voluntarily assume all risks associated with such participation. My student and I understand that the Shattuck-St. Mary’s staff has the right to deny my student's participation and that it is my student's responsibility as a Participant to follow the safety guidelines and procedures established by the Facilitator(s). If, at any time, my student does not understand or has not heard specific instructions given by the Facilitator(s), my student realizes that it is his or her responsibility to ask for clarification and/or assistance.

• My student and I understand and assume all dangers and risks (both known and unknown) associated with my student's participation in the Shattuck-St. Mary’s program and waive, release and discharge Shattuck-St. Mary’s and their agents, officers, and employees from all claims or causes of action arising from my student's participation. I do hereby release Shattuck-St. Mary’s, and their agents, officers, and employees from any and all liability, even if arising from the negligence of the releasees, and agree to indemnify and hold Shattuck-St. Mary’s harmless for any accidents, injury, loss, or damage of property, and from any legal fees that my student may ever have as a direct or indirect result of participating in the Shattuck-St. Mary’s program. This release, indemnification, and waiver shall be construed broadly to the maximum extent under applicable law.

• My signature on this document is also intended to bind my representatives, administrators, successors, heirs, next of kin and assigns on my behalf.

• By selecting Yes and signing below, I am agreeing that I have carefully read and agree to all of the sections above.

• A student may choose to not participate in Challenge Course / Climbing activities even if permission is granted by a parent here, but a student cannot choose to participate if permission is not granted here.
I give my student named above permission to participate in Challenge Course / Climbing Structure activities. *
You do not need to return a printed copy of this webpage to the SSM Admissions Office. The information submitted electronically is sufficient for our records.
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