RIVERSIDE UNIFIED SCHOOL DISTRICT STEM Academy Intro to Enginee ig Design STUDENT PARTICIPATION PARENTAL CONSENT, HOLD HARMLESS AND WAIVER FORM ‘The STEM Academy is offering an Intro to Engineering Design class this school year with activities that may include various constructions of projects, requiring student use of a variety of hand and power tools. Participating students will be trained in the use of such equipment and materials and will be provided with appropriate safety equipment, however, the risk of serious injury or death may exist. ‘The parent/guardian assumes liability for any and all losses that may occur asa result of their child participating in this program. Further, the parent/guardian agrees to defend, indemnify and hold harmless {the Riverside Unified School District, the Board of Trustees, the individual members thereof, and all District, Officers, staff, agents, employees and volunteers from any and all loss, costs and expense, including attorney's fees and costs, or other obligations or claims arising directly or indirectly out of any liability or claim of loss for personal injury, bodily injury to persons, contractual liability, and damage to property, or ‘any other loss, damage, injury or other claim of any kind or nature, arising out of their child’s participation in this program. The parent/guardian agrees to waive any and all claims as to Riverside Unified School District, its’ employees and agents arising from their child's participation in this program. Having understood the types of activities and risks involved in this program, | authorize my son/daughter to Use hand and power tools in the Riverside Unified School District STEM Academy Intro to Engineering Design lass. In signing this consent form, | agree to waive all claims against the Riverside Unified School District and hold the District, its officers, agents, employees and volunteers, harmless from any and all lability or claims, which may arise out of or in connection with my child's participation in this activity. This waiver shall not apply to any occurrences which may arise solely out of the negligence of the District, its employees or agents. Signature of Parent or Legal Guardian Print Name of Parent or Legal Guardian Date Signed Print Name of Student ‘School Name White (site Copy) (Parent/Guardian Copy) Revised Aug 2015