Conejo Valley Unified School District
Extracurricular Event or Activity
Assumption of Risk Form
Voluntary Extracurricular Event or Activity
school-related athletics
school-related club activities
school-related cultural activities
school-related performing arts activities
school-related social activities
school-related community activities
Other: _________________________
I authorize my son/daughter, named above, to participate in the indicated voluntary extracurricular event or activity. I understand and acknowledge that voluntary extracurricular activities, by their very nature, pose the potential risk of serious injury and/or illness to the individuals who participate in such voluntary extracurricular events or activities.
This voluntary extracurricular event or activity, by its very nature, may pose some inherent risk of a participant being seriously injured, before, during, and/or after the activity or event, including transportation whether provided by CVUSD or not. These injuries may include, but are not limited to, the following:
- Sprains and strains
- Fractured bones
- Lacerations, abrasions, and avulsions
- Unconsciousness
- Paralysis
- Disfigurement
- Loss of eyesight
- Head injuries or concussion
- Heat illness
- Sudden cardiac arrest
- Death
- Exposure to infectious diseases
I understand and acknowledge that participation in voluntary extracurricular events or activities is completely elective and voluntary and is not required by CVUSD for completion of promotion or graduation requirements. I also understand that, if I do not consent to my son's/daughter's participation in the voluntary extracurricular event or activity, he/she may be offered an alternative event or activity and possible credit for promotion or graduation may or may not be offered.
I understand that all participants are to abide by and accept all rules and requirements governing conduct and safety in the voluntary extracurricular event or activity. To the extent permitted by the Education Code or other applicable statutes, regulations, policies and procedures, any participant determined to be in violation of safety requirements, behavior standards or other prohibited conduct may be removed from this voluntary extracurricular event or activity.
I understand and acknowledge that in order to participate in these activities, I and my son/daughter agree to assume liability and responsibility for any and all potential risks that may be associated with participation in voluntary extracurricular events or activities.
I also understand that CVUSD, due to the COVID-19 virus or other potential infectious diseases, has undertaken a plan to facilitate a safe environment for educational programs in addition to extracurricular, co-curricular and sport/athletic events or activities. In doing so, I further understand that the LEA/School has adopted plans designed to meet requirements and recommendations of state agencies, health advisors and other responsible bodies. However, I also understand and acknowledge that despite CVUSD's efforts, the risk of infection from the COVID-19 virus, or others, cannot be eliminated at this time, and that my son/daughter may be exposed as a result. I also understand and acknowledge that in participating in this voluntary extracurricular event or activity, my son/daughter will increase his/her interaction with students and staff, and the corresponding risk of contact and infection, and that this may include functions involving other people and/or facilities other than the LEA's. These other students, instructors, assistants, and facilities are potentially operating under a different COVID-19 safety plan, further increasing the risk of exposure of my son/daughter. Finally, I understand, acknowledge, and agree that despite reasonable care and steps by CVUSD, that the virus presents serious challenges to prevention and control, and reasonable efforts by CVUSD does not assure that my son/daughter may not be infected, and that the infection may not be brought home. Despite all of the above I am freely and voluntarily signing this "Extracurricular Event or Activity, Assumption of Risk Form" to enable and authorize my son/daughter to participate and releasing and discharging CVUSD and its/their governing board, officers, agents, employees and/or volunteers from any liability for my son/daughter becoming infected in his/her participation in the event or activity.
I agree to, and do hereby release and hold CVUSD and its governing board, officers, agents, employees and/or volunteers harmless for any and all claims; demands; causes of action; liability; damages; expenses; or loss of any sort, including bodily injury or death; because of or arising out of acts or omissions with respect to the voluntary extracurricular event or activity, including programs or procedures of CVUSD for students and participation in such events or activities.
By typing my name and the name of my child below, I acknowledge that I have carefully read this "Extracurricular Event or Activity, Assumption of Risk Form" and that I understand and agree to its terms.
