I, {parentName}, of {parentAddress:addr_line1}, {parentAddress:city}, {parentAddress:state}, {parentAddress:postal} being of legal age (having been born on {parentBirthdate} acknowledge, declare and agree as follows:

1. That I have voluntarily agreed to allow my child {main_name}, to participate in the University of Southern Maine Upward Bound Program (the “Program”), from today until he/she graduates from high school, and in consideration of my child being permitted to participate in this Program, do voluntarily execute this “Release and Consent Form” on behalf of my self, my heirs and next-of-kin, my personal representatives and my estate.
2. That I hereby give my consent and permission for my child to participate in the Program and to be transported or escorted to and from Portland, Gorham and other locations for field trips and activities part of the Program.
3. That the University of Maine System and the University of Southern Maine (hereinafter referred to as the “University”) has provided me with information describing the Program. I understand there may be dangers and hazards inherent to participants in such programs because of transportation and activities involved, and I personally recognize and appreciate that such dangers and hazards exist. I accept and assume full responsibility for all harm and injury, of every nature, including death, which may occur to me or my child, and for all damages or loss to or in  any personal property owned by me or my child while my child is participating in this Program and during all travel and transportation to and from Portland, Gorham and other locations, and in furtherance thereof I agree to indemnify and hold harmless the University, its Trustees, faculty, employees and agents from and against any and all claims, demands, actions or causes of action, on account of damage or loss to me or my child’s personal property, or to me or my child’s personal injury, or death, which may occur or result directly or indirectly from my child’s participation in this Program and not as a direct result of any negligent act of the University, its Trustees, faculty, employees or agents.
4. I request that this “Release and Consent Form” be construed and interpreted pursuant to the laws of the State of Maine, and if any portion thereof is held invalid, I request the remainder continue in full force and effect.

I declare that I completely understand and have fully informed myself of the terms and conditions of this “Release and Consent Form” and of the Program information provided to  me by having read them, or having them read to me, before signing.

I, {main_name}, declare that I completely understand and have fully informed myself of the terms and conditions of this “Release and Consent Form” and of the Program information provided to me by having read them, or having them read to me, before signing. I agree to these terms and conditions.