I/We, the undersigned, understand that at a Heisey Community Center’s Program(s) physical activity is a regular part of the program.  To the best of my knowledge, my child is in excellent physical health and needs no restrictions (except what is listed under “special challenges/needs”) from strenuous activity.  If I have any questions regarding my child’s health, I understand that it is my obligation to seek professional medical advice and to inform the Heisey Community Center of any restrictions on my child’s activities.

I agree to indemnify and hold the Heisey Community Center, Great Falls Public Schools, and any cooperating agencies involved in the activities and any of their servants, officials, or employees, free and harmless from any liability, loss, cost, or expense including attorney fees, which may result from participation in the activity. I agree that I am fully responsible for payment of all costs resulting from the rendering of medical aid and ambulance services to the listed participant, and I authorize that all necessary first aid steps may be taken as prescribed by qualified personnel. I grant full permission to use photographs, videotapes, recording or any other record of this program for any public relations and/or marketing the Heisey Community Center. By signing below, I agree that I understand and consent to this statement.