Remake Music LLC

Release of Liability and Emergency Medical Release (MAP Afterschool)


Definitions

Remake Music LLC -- Legal Name of Business hosting MAP Afterschool.

MAP Family Learning Center -- "Doing Business As" name of Remake Music LLC.

I -- The legal parent/guardian signing this form.

MAP Afterschool Program -- Afterschool activities conducted as performed by Remake Music LLC, its partners, its employees, and affiliated personal/contractors.

Release of Liability

I give permission to participate in the MAP activities (i.e. lessons, summer workshop, and/or after school program). I will not hold Remake Music LLC, its partners, its employees, any affiliated individual(s) and/or department(s) associated with the MAP Afterschool Program liable for any accidents, injuries, or incidents related to this program. I am aware of the activities that my minor child will participate in, and will ask questions I have regarding activities. I provided all necessary information for the individual listed above in case of an emergency.

Emergency Medical Release

If emergency medical care is necessary and I cannot be reached, I authorize the MAP staff to act in my behalf in granting permission for my child to receive emergency medical treatment. I understand that I am responsible for all expenses incurred as the result of medical treatment. I understand that it is my responsibility to communicate changes in any medical needs my child may have (e.g. allergies, medication, changes in physical and mental health).

Medical information

Note: The following fields are required.

  • Allergies:
  • Medication:  
  • Name of primary doctor: ;  
  • Name of primary hospital:  
  • Emergency contact #1: ;
  • Is emergency contact #1 permitted to pick-up your child/ren?  
  • Emergency contact #2:   ;
  • Is emergency contact #2 permitted to pick-up your child/ren?  

Anything else you would like to tell us:

Note: This field is not required.

COVID-19 Precautions

I agree to notify MAP Afterschool Program staff immediately if my child has COVID-19-related symptoms, has been diagnosed with COVID-19, or has been around others diagnosed with COVID-19. In such an instance, I agree to follow the guidance and instructions set forth by my child's medical professional and the Center for Disease Control and Prevention .

https://www.cdc.gov/coronavirus/2019-ncov/communication/guidance.html

Signature Verifying Agreement

I agree to everything outlined above in Release of Liability, Emergency Medical Release, and COVID-19 Precautions.

 

Leave this empty:

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Signature Certificate
Document name: Release of Liability and Emergency Medical Release (MAP Afterschool)
lock iconUnique Document ID: 166ad8ad3d0fe362dd1ce325a1e6967a4d019e55
Timestamp Audit
August 28, 2021 6:07 pm ESTRelease of Liability and Emergency Medical Release (MAP Afterschool) Uploaded by Devin Ulibarri - devin@remakemusic.net IP 185.220.100.248