FORMULARZ ZGŁOSZENIA UCZESTNICTWA im. Brzechwy

“Northern Poland” March 18-26, 2024
Permission, Release, and Waiver of Liability

As the parent(s) or legal guardian(s) of the below named student (the “Student”), a minor who is enrolled at the Polish Language School in Orland Park, Illinois, Brzechwa, and in consideration of the agreement by the School to permit the Student to participate in the educational tour to Poland to take place from March 18 to March 26, 2024 (the “Tour”), we (the Student and the parent(s) and/or legal guardian(s)), the undersigned, affirm that the Student has permission to participate in the Tour.

Health Insurance. We confirm that there is accident and health insurance coverage for the student that will cover the Student while participating in the trip, and that we agree to maintain coverage in full force and effect for the duration of the trip.

Acknowledgment. By signing this agreement, we (the Student and the parent(s) and/or legal guardian(s)) acknowledge and agree that the Tour may involve risks, dangers, and hazards. The Student’s participate in this Tour is completely voluntary and undertaken at the Student’s own risk, with full acknowledgment that any resulting injury will be a result of the Student’s personal choice and activity/conduct, and not as a result of the School or Rek Travel Services, LLC (“Rek”).

Medical Emergency. We understand there is a risk the Student will sustain injury or become ill during the Tour. In the event that the Student’s emergency contact cannot be reached in an emergency, we give permission to a physician selected by the School to secure proper treatment for the Student in the case of illness or injury. We authorize the use or disclosure of the Student’s health information for purposes of securing health treatment. We agree that we may be required to pay all or most of the expenses incurred for such treatment.

Indemnification. We do further agree to release, waive, discharge, indemnify, hold harmless, and defend the School and Rek, and each of their officers, board members, supervisors, agents, servants, employees, and all private persons or organizations volunteering services without charge to supervise or chaperone students (the “Indemnified Parties) while on the Tour from any and all claims, damages, demands, torts, contracts, obligations, suits, actions, causes of action, losses, or liability (the “Losses”) whatsoever arising out of or relating to the Tour, including, but not limited to, personal injury, property damage, court cost, attorney’ fees and interest, however caused, as a result of the student participating in the Tour, including, but not limited to, medical treatment or services provided to said student while on the Tour. We further promise not to sue the School, Rek, or any Indemnified Party for any illness, injury, death, or other Losses arising out of or relating to the Tour.

Code of Conduct. We do further agree that the School board, its officers, and/or employees reserve the right to terminate the participation of the above student for failure to behave and act in accordance with the School’s regulations on conduct, for failure to follow the instructions and directions of the Tour supervisor(s), and/or chaperones, or for any acts of conduct of the above Student deemed by said board, its officers, agents, and/or employees, to be detrimental to or incompatible with interest, harmony, comfort, or welfare of the tour as the whole. If the participation of the above student is terminated, only the funds not actually used will be refunded, and the student will be sent home at my (our) expense.

Changes. We agree that the School board, its officers, and/or employees reserve the right at any time prior to or during tour to make cancellations, changes, or substitutions in emergencies or changes conditions or in the interest of the group, and to alter, prior to tour departure, the cost in order to meet unexpected changes in airline fares, hotel rates, etc. as the announced fee is based on current tariffs, rates, and expenses which are subject to change or estimates.

Governing Law; Enforcement. This Permission, Release, and Waiver of Liability shall be governed by the laws of the State of Illinois. This Permission, Release, and Waiver of Liability constitutes the sole and entire agreement with respect to the subject matter contained herein. We further expressly agree that the foregoing Permission, Release, and Waiver of Liability is intended to be as broad and inclusive as is permitted by the laws of the State of Illinois, and if any portion of this document is held invalid, then the balance shall, notwithstanding, continue in full legal force and effect.

I, the parent or legal guardian of the Student, have read this Permission, Release, and Waiver of Liability carefully. I am at least 18 years of age. I fully understand its terms. I executed this Agreement knowingly, freely, and voluntarily without any inducement, duress or coercion, intending to be legally bound.

I, the Student, have read this Permission, Release, and Waiver of Liability carefully. I understand that I must behave in accordance with the Code of Conduct, detailed above. In addition, I acknowledge that I have read and understood all of the terms of this document and that I hereby consent and agree to the terms and conditions of the Permission, Release, and Waiver of Liability.