Participation & Field Trip Liability Waiver

As the parent and/or legal guardian of the student listed above, I authorize and permit my child to participate in any and all academic year component activities (classes, tutorials, workshops, field trips, work study internship, meetings and events, etc.) sponsored and/or conducted by the LNESC Upward Bound Project. I also give permission for my child to be transported between his/her high school, and scheduled events. I acknowledge the nature of such activities or trips may expose my child to hazards or risks that may result in his or her illness, personal injury or death, and I understand the nature of such hazards and risks.

In consideration of my child being permitted to participate in the activity or trip, I hereby accept all risk to his/her health and of his/her injury or death that may result from such participation, and I hereby release the LULAC National Educational Service Centers, Inc., its governing board, officers, employees and representatives from any and all liability to my child, his/her personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss or damage to my child’s property and for any and all illness or injury to his/her person, including his/her death, that may result from or occur during his/her participation in the activity or trip, whether caused by negligence of the LULAC National Educational Service Centers, Inc., its governing board, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless the LULAC National Educational Service Centers, Inc., its governing board, officers, employees, and representatives from liability for the injury or death of any person (s) and damage to property that may result from my child’s negligent or intentional act or omission while participating in a project activity or event.

I have carefully read this agreement and understand it to be a release of all claims and causes of action for my child’s injury or death or damage to his/her property that occurs while participating in UB Project activities or trips and it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my child’s negligent or intentional act or omission.

As the parent/guardian of the above named student, I hereby authorize the Director and his/her staff to furnish medical diagnostic and/or authorize the medical and/or surgical treatment of my child as may be considered necessary or appropriate under the circumstances for the treatment of any illness or injury of the child. The LULAC National Educational Service Centers, Inc. and its officers, and employees shall not be liable in any way for any consequences from said diagnostic, medical and/or surgical treatment and are hereby released from any and all claims and causes of action that may arise out of such diagnosis, treatment or surgery to the extent allowed by law, except as provided for through the group medical insurance plan if the student contracted for the same prior diagnosis, treatment or surgery. Furthermore, LNESC does not assume any financial or other responsibility, but wishes to provide the best services possible in case of emergency.

In case of sudden illness or accident, I consent to emergency treatment by the nearest professional medical staff to my child. In case of serious illness/accident I will be notified immediately, but if I cannot be reached, necessary interim emergency care may be provided by a qualified medical staff.

INSTITUTION:
LNESC Albuquerque
625 Silver Ave SW, Suite 324
Albuquerque, NM 87102
(505) 243-3787

DESCRIPTION OF ACTIVITY OR TRIP (including transportation to and from):
Includes all Upward Bound related activities including field trips and special events.

LOCATION: Various

DATE(s): All

I am the Parent/Guardian of the above-named Participant who is under eighteen years of age and am fully competent to sign this Agreement.

I give permission for (Student Listed Above) to participate in the above-referenced activity or field trip. I acknowledge that the nature of the activity or trip may expose my son/daughter to hazards or risks that may result in his/her illness, personal injury or death and I understand and appreciate the nature of such hazards and risks.

In consideration of my son/daughter being permitted to participate in the activity or trip, I hereby accept all risk to (Student Listed Above) health and of his/her injury or death that may result from such participation and I hereby release the above named institution (LNESC),its employees, governing board, officers, and representatives from any and all liability to (Student Listed Above), personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to his/her property and for any and all illness or injury to his/her person, including death, that may result from or occur during (Student Listed Above) participation in the activity or trip, whether caused by negligence of the institution, its governing board, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless the institution and its governing board, officers, employees, and representatives from liability for the injury or death or any person(s) and damage to property that may result from (Student Listed Above) negligent or intentional act or omission while participating in the described activity or trip.

I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR PARTICIPANT'S INJURY OR DEATH OR DAMAGE TO PARTICIPANT'S PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED ACTIVITY OR TRIP AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY PARTICIPANT'S NEGLIGENT OR INTENTIONAL ACT OR OMISSION.

Upon acceptance into the Upward Bound program, the student must sign and comply with the following annual contract in order to remain in the program and earn a monthly stipend.

STUDENT: As a participant in the Upward Bound Program, I agree to the following:

1. I understand that my attendance is mandatory for ALL Upward Bound scheduled programming, activities, workshops, field trips, and individual meetings.
2. I understand that my parent must directly contact the Coordinator if I will be absent or late to any UB programming or activities.
3. To have a positive attitude and behave in a respectful manner that is neither disruptive nor rude during all programming, activities, workshops, field trips and individual meetings.
4. To provide the UB Coordinator or Advisor a copy of all six weeks and semester grade reports.
5. I will attend all assigned and required tutoring sessions if I receive a C or below in any core high school course for any six weeks reporting period.
6. I will turn in all tutoring and homework assignments and actively participate in all UB classes and workshops.
7. I will seek help from the Coordinator, Advisor, or tutor.
8. I will respond to all emails, texts, phone calls from UB Coordinator or Advisor in a timely manner.
9. I will accomplish goals that I have set with the help of the Coordinator and/or Advisor.
10. I will enroll in a college or university upon high school graduation.
11. I will follow all UB policies and procedures currently stated in the UB Program Student/Parent Academic Component Handbook.

I understand that being part of the Upward Bound Program is a PRIVILEGE & understand and agree to accept the duties and responsibilities outline above. I understand that FAILURE to ADHERE to any of the above mentioned conditions may result in being placed on probation or possible removal from the Upward Bound Program.

PARENT: As the Parent of a Participant in the Upward Bound Program, I agree to the following:

1. I understand that my child’s attendance is mandatory for ALL Upward Bound scheduled programming, activities, workshops, field trips and individual meetings.
2. I understand that I must directly contact the Coordinator if my child will be late to any UB programming or activities.
3. I understand that my child must attend all assigned and required tutoring sessions if he/she receives an C or below in any core high school course for any six weeks reporting period.
4. I will attend all Parent Orientations and Seminars sponsored by UB as scheduled.
5. I will take an active part in my child’s education, supervising study and helping if needed.
6. I will follow all UB policies and procedures currently stated in the UB Student/Parent Academic Component Handbook.

1) Student Information

2) PARENT/GUARDIAN CONTACT INFORMATION: Please provide updated parent contact information. Please fill out completely, if information unavailable please put N/A.

3) Release of School Records

I authorize the LNESC Upward Bound Project of Atrisco Heritage Academy High School, Highland High School, and Valley High School to access and/or receive copies of my academic transcripts, grade reports, report cards, SBA/ACT scores, and any other academic information and test results necessary to complete the program’s application process. Additionally, I grant the LNESC Upward Bound program permission to access my student’s grades through APS StudentVUE