By signing below, I represent and agree as follows:
I am the parent or legal guardian of the above named MSDA student and have the legal right to consent to this Authorization and Release on behalf of my child, myself, and my child's other parent and guardian(s), if any. I further represent that my child is at least 11 years old.
I understand MSDA's policy to protect child safety by requiring students under the age of 7 to be supervised by parents at all times and by requiring children ages 7 and older to be dropped off and picked up inside MSDA's building by parents. For my own reasons and because I believe my child has the maturity to leave MSDA's facilities without supervision, I hereby request and authorize MSDA to allow my child to leave MSDA's facilities following or between participation in MSDA classes and programs. I understand that MSDA will not be supervising my child once he/she has left MSDA's facilities (including on the sidewalk, parking lot, or any other locations or areas outside of MSDA's building) and that it is my responsibility to give my child instructions and put safeguards in place for my child. I also understand that once this form is signed, my child will be permitted to leave MSDA's facilities without further inquiry whenever my child is not actively participating in a MSDA class or program.
IN CONSIDERATION OF MSDA PERMITTING MY CHILD TO REMAIN IN ITS PROGRAM WITH THIS EXCEPTION TO ITS POLICY, I, ON BEHALF OF MY CHILD, MYSELF, MY CHILD'S OTHER PARENT AND GUARDIAN(S) (IF ANY), AND MSDA AND ALL ITS OWNERS, OFFICERS, DIRECTORS, REPRESENTATIVES, EMPLOYEES, AGENTS, VENDORS, CONTRACTORS, INSURERS, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, THE "RELEASEES") FROM AND AGAINST ANY AND ALL LIABILITY, CLAIMS, ACTIONS, AND CAUSES OF ACTION, WHETHER KNOWN OR UNKNOWN, WHETHER NOW EXISTING OR ACCRUING IN THE FUTURE, ON ACCOUNT OF PERSONAL INJURY, ILLNESS, DEATH, PROPERTY DAMAGE, OR OTHER LOSS ARISING OUT OF OR RELATED IN ANY WAY TO MY CHILD'S UNSUPERVISED DISMISSAL FROM MSDA FACILITIES. THIS RELEASE SPECIFICALLY INCLUDES INJURY, ILLNESS, DEATH, PROPERTY DAMAGE, AND OTHER LOSS CAUSED BY THE NEGLIGENCE OF MSDA AND/OR OTHER RELEASEE(S), BUT EXCLUDES INJURY, ILLNESS, DEATH, PROPERTY DAMAGE, AND OTHER LOSS CAUSED BY THE GROSS NEGLIGENCE OR WILLFUL OR WANTON MISCONDUCT OF MSDA AND/OR OTHER RELEASEE(S). WE COVENANT THAT NEITHER I, NOR STUDENT, NOR THE OTHER RELEASORS WILL MAKE OR BRING ANY SUCH CLAIM AGAINST MSDA OR ANY OTHER RELEASEE, AND WE FOREVER RELEASE AND DISCHARGE MSDA AND ALL OTHER RELEASEES FROM LIABILITY UNDER SUCH CLAIMS. This Authorization and Release is in addition to, and does not supersede or limit in any way, any other release(s) I have entered into for the benefit of MSDA and/or the other Releasees.
