Parent/Guardian Health Authorization & Release from Liability

The above health history information is correct and complete. The student herein described has permission to engage in all camp activities except as noted.

I, the parent/guardian of (Student’s Name), hereby give permission to the camp to provide routine healthcare, administer prescribed medications, and seek emergency medical treatment, including ordering of x-rays or routine tests. I give permission to the physician selected by the school to secure and administer treatment for the named student including emergency medical or surgical treatment and hospitalization, if necessary.

I will be financially responsible for any medical attention needed during camp or resulting from any injury received at camp.

I HEREBY WAIVE AND RELEASE Western International School of Shanghai, ITS OWNERS, AGENTS, PARTNERS, FACILITY PROVIDERS, AND EMPLOYEES FROM LIABILITY FOR ANY INJURY OR ILLNESS INCURRED WHILE AT CAMP, RESULTING FROM ORDINARY NEGLIGENCE. I UNDERSTAND THAT THERE IS RISK OF INJURY TO THE NAMED STUDENT AS A RESULT OF CAMP ACTIVITIES, AND KNOWINGLY AND VOLUNTARILY ASSUME ALL RISK OF SUCH INJURY. HOWEVER, I UNDERSTAND THAT I AM NOT RELEASING Western International School of Shanghai, ITS OWNERS, AGENTS, PARTNERS, FACILITY PROVIDERS, AND EMPLOYEES FROM GROSS NEGLIGENCE, RECKLESS CONDUCT OR INTENTIONALLY TORTIOUS CONDUCT. TO THE EXTENT THIS RELEASE CONFLICTS WITH CHINESE LAW GOVERNING RELEASES, THIS RELEASE IS TO BE GIVEN THE FULLEST FORCE AND EFFECT PERMITTED UNDER CHINESE LAW. IF THIS RELEASE IS DETERMINED TO BE INVALID UNDER THE LAWS OF THE GOVERNING STATE, THEN THIS RELAESE SHALL BE STRICKEN FROM THIS CONTRACT, BUT ALL OTHER TERMS AND CONDITIONS OF THIS AGREEMENT SHALL REMAIN IN FULL FORCE AND EFFECT.

Name of Parent/Guardian: 

Signature / Date

By the above signature, it certifies that I, the Parent/Guardian, whose name is displayed above, agree to the terms stated above, and have taken the time to ensure that ALL information in this REGISTRATION FORM IS UP-TO-DATE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

For USD Payment
Account Name: Western International School of Shanghai
Account Number: 31014938000220002617
Bank Information: China Construction Bank Qing Pu Branch
550 Cheng Zhong Road East, Qing Pu District
Shanghai, PRC 201702

For RMB Payment
Account Name: 上海西华国际学校 (Western International School of Shanghai)
Account Number: 076648-97460155200000409
Bank Information: Shanghai Pudong Development Bank, Cao He Jing Branch, 461 Hong Cao Road, Shanghai, PRC 200233