Teen CERT Program – Risk Waiver Form Teen CERT Program - Risk Waiver Form The form below must be signed and submitted prior to starting the online course. Complete the form and hit SEND. PARENTAL CONSENT AND RELEASE, INDEMNITY AND ASSUMPTION OF RISK FORM By submitting this Waiver, I, being the Parent or Legal Guardian of the Teen CERT participant (Minor), listed below, hereby consent to and authorize the Minor to act as a volunteer participant in the Teen CERT Academy and in the Teen CERT Program (together known as “Teen CERT Program”) provided by the Los Altos Hills County Fire District (District). I acknowledge and agree that activities performed by the Minor as a volunteer will be performed strictly on a voluntary basis, without any pay, compensation, or benefits. I agree and understand that the Minor must comply with the rules and regulations established from time to time by the District and that failure to do so may result in the Minor’s immediate removal as a volunteer. I am generally aware of the nature of the activities to be performed by the Minor as a volunteer. I agree that all volunteer activities are to be performed by the Minor at the Minor’s risk and I assume full responsibility therefore. Photographic Release. I understand the Minor may appear in news articles, social media, and training videos or other recordings or written articles of the Teen CERT Program activities that may be generally available and/or broadcast on the internet or written media. I hereby give my permission and consent, now and for all time, to the District and third parties collaborating with the District to make, reproduce, edit, broadcast or rebroadcast any articles, media, video film, footage, soundtrack recordings and photo reproductions of the Minor without any compensation to, and/or claim, by the Minor. On behalf of myself, the Minor, and our respective heirs and personal representatives, I HEREBY WAIVE, RELEASE AND DISCHARGE the Town of Los Altos Hills, The Los Altos Hills County Fire District, the County of Santa Clara, and Santa Clara County Fire Department, and their respective agents and employees (Indemnified Parties) from and against any and all liability for any claims, demands, loss, personal injury of any nature or cause arising out of Minor’s participation in the Program, excluding liability arising out of the sole negligence and/or willful misconduct of the Indemnified Parties. On behalf of myself, the Minor, and our respective heirs and personal representatives, I agree to indemnify, defend, and hold the Indemnified Parties free and harmless from and against all claims, damages, losses and expenses, including attorney fees, that my minor child may sustain as a result of the Minor’s participation in the Program. I expressly agree that the waiver, release, and indemnity contained herein is intended to be as broad and inclusive as permitted by the laws of the State of California, and that they shall be governed by and interpreted in accordance with the laws of the State of California. I agree that in the event that any clause or provision of this document shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this document which shall continue to be enforceable. Parent/Legal Guardian Signature I have carefully read this document and fully understand its contents. Name of Parent or Legal Guardian* First Last Email of Parent or Legal Guardian* Enter Email Confirm Email Name of Teen CERT participant (Minor)* First Last Email of Teen CERT participant (Minor)* Enter Email Confirm Email Emergency Contact InformationEmergency Contact Name* First Last Emergency Contact Phone*By clicking SEND which submits this Parental Consent and Release, Indemnity and Assumption of Risk Form, I hereby consent to and authorize the Minor to act as a volunteer participant in the Teen CERT Academy and in the Teen CERT Program (together known as “Teen CERT Program”) provided by the Los Altos Hills County Fire District (District). You will receive a confirmation of your submission via email.