In order to participate in any/all DuCAP Activities, Events, Programs, and/or Field Trips, a Waiver of Liability needs to be completed. You will not be able to participate until this is completed. Once completed, this waiver will apply to any/all DuCAP-related Programs, Events, Activities, & Field Trips. We do not share or sell any personal information. Demographic information is reported to our funders in bulk and not on an individual basis. Information is kept confidential. If you have any questions, comments, concerns, please do not hesitate to reach out to us via email at info@ducap.org or call us at 630-671-8000.
I hereby give permission to the medical personnel selected by DuPage County Area Project (DuCAP) to transport myself/child listed to a medical facility for treatment. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by DuCAP personnel to secure and administer treatment, including hospitalization, for myself/child or children listed. I release, waive, discharge, and agree not to sue DuCAP, its departments, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as “releases”, from any and all liability to the participant, his or her heirs and next of kin for any and all claims, demands, medical bills, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise.
In consideration of myself and/or my child/children participating in DuPage County Area Project (DuCAP) activities, the undersigned acknowledges, appreciates, and agrees that: Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for myself and/or my child/children participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe any unusual or significant hazard during my presence or participation of myself or my child, I will remove myself and/or my child from participation and bring such to the attention of the nearest official immediately; and, I, for myself and my child on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS DuPage County Area Project (DuCAP), their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I authorize the Illinois Department of Human Services, any Affiliate or Sponsor/Partner of DuPage County Area Project (DuCAP), and DuCAP Staff and Volunteers to photograph myself/child/children listed for means of publication purposes. Photos might be used in various media formats to describe and promote the program in a positive way. The photos will not be used in any illegal misrepresentation of my child/children listed. There will be no compensation for any images used. If this is a concern & you would still like yourself and/or your child/children listed to participate, please reach out to DuCAP directly at info@ducap.org and/or 630.671.8000.
I give my permission to the Illinois Department of Human Services, its designees and DuPage County Area Project (DuCAP) to collect and record data on myself and/or my child/children listed. The data may include, but is not restricted to the following: Surveys and/or interviews about his/her knowledge, attitudes, skills, and behaviors in regard to risk-taking behaviors and habits, education and educational resources, positive relationships, career choices, connection to community, and overall satisfaction with the DuCAP Program. Academic and school department data from report cards and other school reports. This may be collected each quarter during the school year. I understand that the purpose of these surveys and interviews is to document the impact of the DuCAP Program on its participants and to identify areas for improvement. I also understand that this information will remain private and that only designated DuCAP representatives will be able to view this information. If this is a concern & you would still like yourself and/or your child/children to participate, please reach out to DuCAP directly at info@ducap.org and/or 630.671.8000.
In an effort to run organized programs, events, and activities, waivers must be completed by parent/legal guardian of anyone under 18 years of age. All participants must be recorded and accounted for during DuCAP-supported events. Myself and/or my child, or children listed and I fully understand that all DuCAP rules apply. I will allow myself and/or my child/children listed to go on field trips and/or events with the DuCAP program and staff and ride in a vehicle supplied by DuCAP for travel to and from event / program / activity locations. I understand that some events and/or field trips will also have more information, providing details concerning the exact logistics of the trip.
DuCAP is not responsible for the receiving and releasing of a participant under 18 years old. It is the full responsibility of the parent/legal guardian to ensure they are received and released from DuCAP activities, events, and/or programs.
I understand that DuPage County Area Project (DuCAP) may present audio/visual presentations that carry a G, PG, or PG13 rating. I allow myself and/or my child/children listed to view/listen to a G, PG, and PG-13 rated presentation.
Participants and volunteers are encouraged to get their own mode of transportation to DUCAP programs and events. As DUCAP is not responsible or liable for the transportation of any individuals, I agree to take full responsibility and hold DUCAP harmless of any liability should I and/or my child/children decide to transport any participant or volunteer.
We may need to email, text, and/or call you / your child for reasons including, but not limited to: emergencies, reminders, cancellations, etc. Those who want to be the first to know about future events and volunteer opportunities can sign up for our text/email clubs.
Please select at least one of the following:
We do not share or sell any personal information. Demographic information is required when reporting to our funding sources and is kept confidential.
*** I/Parent/Legal Guardian, completing this form, confirm that I have read and understood the above information and give my consent accordingly. I also agree to notify DuPage County Area Project (DuCAP) IMMEDIATELY of any changes to the above information I have supplied and hold DuCAP harmless of any liability***
