Placemaking Through Landscape Design

As the parent or guardian, I certify that my minor child or ward has my permission to participate in the summer program(s) selected on this form. 

I/We do hereby delegate to Lawrence Technological University Summer Programs employees and authorities the authority to seek, obtain, and approve any medical care and treatment needed and rendered under the general supervision of any physician or surgeon which, in their judgment, is necessary for the health and well-being of said minor child during his/her participation in the Lawrence Technological University Summer Programs.

I/We assign payment to those medical vendors for all services that these same medical vendors may render. It is understood that this authorization is given in advance of any specific diagnosis, or treatment or medical care being required and is to serve as specific consent to any and all such diagnoses, treatment, or hospital care which may be deemed advisable. I/We understand that I/we are responsible for any costs incurred that are not covered by insurance and I/we agree to hold Lawrence Technological University and the Lawrence Technological University Summer Programs and its employees harmless for any liability arising or of any good faith action taken in obtaining medical treatment for the above-named minor child.

In consideration of the participant in the Lawrence Technological University Summer Programs, the undersigned parent/guardian hereby releases and holds harmless the Lawrence Technological University Board of Trustees and its employees and the Lawrence Technological University Summer Programs and its employees from any and all liability occurring during the
participation of the undersigned minor child. In particular, the undersigned parent/guardian acknowledges that he/she and such minor child will not hold Lawrence Technological University or the Lawrence Technological University Summer Programs liable for any expenses, property damages, personal injuries and/or death sustained by such minor child while participating in the Lawrence Technological University Summer Programs. Furthermore, the undersigned parent/guardian acknowledges that he/she, prior to the commencement of the Lawrence Technological University Summer Programs, is aware of and understands the risks involved in such activity, and is prepared to assume, on behalf of such minor child and himself/herself, all such risks as his/her and the minor child’s sole responsibility.

It is my understanding that said minor child will be subject to the rules and regulations of the Lawrence Technological University Summer Programs. I understand that any student found in possession of fireworks, explosives, any and all weapons, or is under the influence of alcohol or illegal drugs will be immediately expelled from the Lawrence Technological University Summer Programs. I also understand that if my child repeatedly disobeys University or Lawrence Technological University Summer Programs policies and regulations, he/she may be expelled from the program.

I hereby consent and authorize Lawrence Technological University, its successors, and assigns, to utilize photographic or video images of my child and/or audio recordings of his/her voice in Lawrence Tech advertising and promotion. Receipt of full consideration is hereby acknowledged and no further claims of any nature will be made.

The terms and conditions of this Agreement shall be legally binding upon the undersigned parent/guardian and such minor child and his/her respective estate, representative, and assigns.