Note: Registration deadline is June 15, 2016
I hereby grant permission for
(the Participant) to attend and fully
participate in the Learning to Lead Youth Summer Program, and I hereby release Lewis
University, its Trustees, its agents and employees from any liability therein. I am aware of no
condition which would prohibit the Participant from participating in any activities of the Program
(the Participant) has received a physical examination within the
last twelve (12) months.
By my signature affixed below, I acknowledge the risk involved and assume all responsibility for the safety and conduct of the Participant while using the Lewis facilities.
Participants agree to follow and be bound by the rules and regulations as outlined in the Lewis University Handbook and all local, state and federal laws.
I, the undersigned, acknowledge that I have read and understand the above agreement and agree to be bound by the terms of this agreement
*Name of Parent/Guardian (printed name will serve as an electronic signature):
A Parent/Guardian must complete the following information as well:
All Sales are final.
Lewis University is authorized to operate as a postsecondary educational institution by the Illinois Board of Higher Education.
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