ACTIVITY PARTICIPATION FORM

Fill out the form below for Emergency Consent, Activity Participation and Insurance Waiver information. Please be sure to scroll through and read all of the statements and terms in the box below before continuing to fill out the form.

I, as the parent/guardian, do hereby enter into this St. Thomas High School Activity Participation, Consent, Insurance Waiver, and Release of Liability Agreement (“Agreement”), and voluntarily and willingly permit my child to participate in activities or tours (the “Activity”) at St. Thomas High School (“St. Thomas” or “STHS”) or at other locations where such Activities may be held.I understand participation in this Activity is completely voluntary and agree that NO INSURANCE COVERAGE MAY EXIST THROUGH STHS TO COVER ANY CLAIMS THAT MAY ARISE OUT OF MY CHILD’S PARTICIPATION IN THE ACTIVITY. It is understood that the parent/guardian and/or their private insurance will cover any charges incurred that may arise out of their child’s participation in the Activity. In consideration for STHS allowing my child to participate in this Activity and knowing that I would be required to sign this Agreement releasing STHS from any and all liability, I acknowledge that I have fully read, and hereby execute, this Agreement with the intent to bind myself, my spouse (if applicable), child, my heirs, assigns, and legal representatives. I further state that I am at least 18 years of age and competent, and have the authority, to sign this Agreement releasing STHS from any and all liability on my behalf and on behalf of my child.

I fully understand and acknowledge that certain elements of the Activity may be physically hazardous and emotionally demanding and that by my child’s participation in the Activity, he/she faces the risk of accidental and/or other injury. These risks include, but are not limited to, (1) traveling to and from the Activity, including traveling off-campus, as needed, via any means of transportation provided by STHS; (2) loss or damage to personal property; (3) injury or fatality due to, and/or related to, (a) walking, running, jumping, handling equipment, being exposed to others handling equipment, colliding with other individuals; and/or other physical activity; (b) head, neck, arm, leg, and/or back injuries; (c) the condition of facilities; (d) exposure to inclement weather, outdoor terrain, and all the risks inherent therein; (e) slips and falls; and (f) any and all other aspects and stress related to the Activity, including interaction with personnel who may not be employees of STHS, among others. I understand St. Thomas provides supervision and transportation for the Activity, but does not assume responsibility for accidents or injuries which might be sustained during the Activity or while traveling to or from the Activity.

I have fully investigated the nature of the Activity, including whether participants will be subjected to physical and/or emotional stresses, and I assume the risks of my child’s participation in the Activity. I agree that my child’s participation in the Activity is entirely voluntary and that my child is under no obligation to take part in the Activity. I am fully aware that my child may suffer these or other injuries arising out of my child’s participation in the Activity and I acknowledge that the Activity may be a dangerous activity. However, I allow my child voluntarily to assume these risks and participate in the Activity. My child and/or I agree to advise his/her supervisor at any point when my child questions his/her ability to participate in any activities of the Activity. I further acknowledge that my child has asked for and has received reasonable accommodations for any disability my child may have brought to the attention of the Supervisor, having first presented any required valid certification of his/her disability to the Supervisor, if necessary, depending on the Activity. I acknowledge and understand that STHS makes no warranties, either express or implied, as to the condition and/or safety of the premises or property at which the Activity is conducted, whether at STHS or at some other location.

IN CONSIDERATION FOR THE RIGHT OF MY CHILD TO PARTICIPATE IN THE ACTIVITY, I EXPRESSLY AGREE AND INTEND THAT MY CHILD’S PARTICIPATION IN THE ACTIVITY SHALL BE UNDERTAKEN BY MY CHILD AT HIS/HER OWN RISK AND THAT NEITHER STHS, ITS’ DIRECTORS, MEMBERS, OFFICERS, TEACHERS, COACHES, EMPLOYEES, AGENTS NOR AFFILIATES NOR ASSIGNS SHALL BE LIABLE FOR ANY INJURIES, DAMAGES, CLAIMS, DEMANDS, ACTIONS OR CAUSES OF ACTION WHATSOEVER WHICH MAY ARISE OUT OF OR IN CONNECTION WITH MY CHILD’S PARTICIPATION IN THE ACTIVITY, WHETHER FROM ACTS OF ACTIVE OR PASSIVE NEGLIGENCE ON THE PART OF MY CHILD OR ON THE PART OF STHS, ITS DIRECTORS, MEMBERS, OFFICERS, TEACHERS, COACHES, EMPLOYEES, AGENTS, AFFILIATES AND ASSIGNS, AND I DO HEREBY FOREVER RELEASE, DISCHARGE, INDEMNIFY, HOLD HARMLESS AND WILL DEFEND STHS, ITS DIRECTORS, MEMBERS, OFFICERS, TEACHERS, COACHES, EMPLOYEES, AGENTS, AFFILIATES AND ASSIGNS FOR ANY SUCH INJURIES, DAMAGES, CLAIMS, DEMANDS, ACTIONS, OR CAUSES OF ACTION.

PHOTO - VIDEO RELEASE

St. Thomas High School and its affiliates often use photographs and video images of students, faculty and staff in publications, media, public relations, fund raising and recruiting material.

I consent and give permission to St. Thomas High School and its affiliates to use photographs and/or video images of the student in publications, media, public relations, fund raising and recruiting material.

STUDENT CODE OF CONDUCT

STUDENTS NEED TO KEEP THEIR PERSONAL BELONGINGS (INCLUDING BACKPACKS) WITH THEM AT ALL TIMES. PLEASE DO NOT LEAVE ANY BELONGINGS IN THE HALL.

Disciplinary action may be imposed whenever a student commits or attempts to commit any act of misconduct on the St. Thomas High School campus or St. Thomas activity, including but not limited to:

  1. Possession, use or distribution of an illegal or controlled substance, or look-alike drug
  2. Unauthorized and/or illegal possession, use or distribution of any alcoholic beverage.
  3. Smoking, chewing or e-cigarettes are not permitted on campus at any time
  4. Theft of property or services.
  5. Intentional or willful and wanton destruction of property.
  6. Assault and/or battery
  7. Possession of a weapon
  8. Conduct which constitutes harassment or abuse that threatens the mental well-being, health or safety of any individual

Any disciplinary problems arising in or out of the Activity, classroom or camps by any student will be reported to the Dean of Students Office. Disciplinary action may be imposed whenever a student commits or attempts to commit any act of misconduct on the St. Thomas High School campus or participation in a St. Thomas activity. Violation could mean immediate withdrawal from the Activity.

BEHAVIOR CODE OF CONDUCT AGREEMENT

I, the parent/guardian, and student understand and agree to abide by the St. Thomas High School Code of Conduct. I acknowledge that we are fully aware of the consequences resulting from the violation of any of the guidelines and agree to comply with the Code of Conduct.

MEDICAL CONSENT TO TREAT

I, as the parent/guardian, do hereby authorize the Licensed Athletic Trainer or school representative on my behalf, to consent to any medical treatment deemed necessary by any licensed physician/surgeon in the event of illness or injury to my child. This consent to treat is intended to cover any illness or injury sustained while participating in any school activity or event, on or off campus, and while traveling to and from the event. I understand that this authorization is given in advance of any specific diagnosis and resulting treatment or hospital care required. This authorization is given to provide the aforesaid agent(s) the power to give specific consent to all such diagnosis and resulting treatment or hospital care deemed advisable by the aforementioned physician/surgeon in the event the parents/guardians or emergency contacts are not able to be reached. I hereby authorize any hospital, which has provided treatment to my child to surrender custody of my child to the Licensed Athletic Trainer or school representative upon completion of treatment.

These authorizations shall remain effective until the end of the activity the student is participating in.

The terms of this Agreement are to be governed by and construed under the laws of the State of Texas. In the event any term or provision of this Agreement is found to be unenforceable or void, in the whole or in part, the term or provision concerned shall be construed as valid and enforceable to the maximum extent permitted by law, and the balance of this Agreement shall remain in full force and effect. I agree that exclusive venue for any dispute arising between STHS and me involving this Agreement in any way shall be in Harris County, Texas.

NOTICE: THIS FORM MUST BE FILLED OUT AND SUBMITTED PRIOR TO PARTICIPATION IN THE ACTIVITY/ACTIVITIES AT OR WITH ST. THOMAS HIGH SCHOOL

PARENT/GUARDIAN INFORMATION

STUDENT INFORMATION

EMERGENCY INFORMATION