COLORADO SCHOOL OF MINES

Webelos Scout Badge Day ASCE/AGC/ASME/IEEE/UCA Outreach Event Child Participant Liability Waiver Form

I, the undersigned parent, desire to enroll my child in the Webelos Scout Badge Day Event (hereinafter the “Program”) to be held at the Colorado School of Mines (hereinafter “CSM”) on Saturday, November 2, 2013, from 8:30 a.m. to 2:00 p.m. I understand that the Program shall be conducted for the entertainment and educational benefit of the participating children and acknowledge that my child’s participation in the Program is voluntary. I understand that the Program shall include the following activities: Marshmallow Bridge, Catapult, Battery Motor, and other educational activities. I understand that appropriate adult supervision of the activities will be provided by CSM. I am aware that the Program activities, while not inherently dangerous, nonetheless involve a certain degree of risk. Despite my awareness of this risk, it is my desire that my child participate in the Program. In consideration for the opportunity to enroll my child in the Program, I hereby voluntarily assume full responsibility for all risks of loss, property damage or personal injury, including death, that may be sustained by me or my child as a result of my child’s participation in the Program, whether caused by the negligence of CSM or otherwise. I specifically release the State of Colorado, CSM, the Board of Trustees of CSM, and all agents and employees of CSM from any and all liability resulting from or relating to my child’s participation in the Program. I am executing this document voluntarily on the date written below on behalf of myself, my spouse (if applicable), and my child with full knowledge of my legal rights with regard thereto. ______________________________________ ___________________________________ Parent or Guardian Name (Please Print) Child Participant’s Name (Please Print) ______________________________________ ___________________________________ Parent or Guardian Signature Date