Center for Student Coastal Research Summer Program
2005: "Seaside Adventures"
40 Parker Avenue Cohasset, MA 02025
www.ccscr.org
40 Parker Avenue Cohasset, MA 02025
www.ccscr.org
Consent,Waiver and Indemnity Agreement
THIS FORM MUST BE SIGNED PRIOR TO ANY STUDENT PARTICIPATION WITH THE PROGRAMS. BY SIGNING THIS AGREEMENT, THE PARENT/GUARDIAN AFFIRMS HAVING READ IT.
I hereby give permission for my child to participate in all CSCR activities including transportation. In the event of an emergency, I/we as the parent(s) or guardian(s), understand every effort will be made to contact me/us. In the event parent(s) or guardian(s) cannot be reached I/we hereby give permission to the physician selected to secure proper medical treatment which may include hospitalizatin, anesthesia, surgery or injection of medication for my/our children. I/we do for my child,myself, and our personal representatives, family, heirs and assigns, knowingly and freely waive all claims against and release and discharge CSCR and its officers, directors, agents, employees and volunteers from any and all liability,loss, damage and expense which may result from participation in CSCR programs. CSCR reserves the right to photograph CSCR participants for publicity purposes.
Parent/Guardian Signature: _____________________________ Date:_________________________
Registration/Cancellation
Policies: All forms and tuition must be paid in full by May 31,2005.
The tuition is refundable provided that CSCR office receives written notice
of cancellation by May 31, 2005. There will be no tuition refunds made after
May 31, 2005.There will be a $25 fee for cancellations prior to May 31,2005.
We require that students submit a copy of a physical examination performed
by a licensed physician within the previous 12 months, accompanied by a
current immunization record. Please contact us if you seek Financial Assistance
781-383-0129.