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Douglas Police Department Youth Activities Release of Liability I, release the City of Douglas, Converse County School District and all presenters from any liability or responsibility pertaining to accidents, injuries, or complications resulting from activities or while transporting said student to or from activities. I authorize the leadership personnel to transport the above child to the nearest hospital in case of injury or suspected injury while the student is involved in the Activities, or to call for an ambulance. I further authorize the hospital and its attending physician to administer necessary emergency professional medical care to the above child upon his/her arrival at the hospital. I further authorize my child to participate in the use of the rock climbing wall as presented at the activity. Student’s name: Parent or legal guardian Date: