INDEMNITY & RELEASE
To: Austin Japanese School
Name(s) of Student(s) (minor): _______________________________________
_______________________________________
_______________________________________
In consideration for my minor child whose name is as written above (the “Student”) being allowed enrollment and participation in activities associated in any way with Austin Japanese School (the
“Activities”), on behalf of the Student, I hereby enter into this INDEMNITY & RELEASE.
1. I recognize and understand that there are risks associated with enrollment and/or participation in the Activities including, but not limited to, bodily injury and damage to property.
2. I agree to indemnify, defend and hold harmless Austin Japanese School and its teachers, officers, clerks, PTAs and their patrol (hereinafter named the “Indemnified”), from and against any and all claims, demands, losses, damages, causes of action, suits and liabilities for injury to or illness of the Student, or for loss or damage to any property, directly or indirectly arising in any way out of or in relation to any act of the Student incidental to the Activities, even through caused by or arising from the active or passive, sole, joint or concurrent negligence of the Indemnified.
3. I authorize the Indemnified to obtain medical assistance to and/or treatment for the Student when deemed necessary by the Indemnified and agree to pay all costs associated with such medical assistance and/or treatment.
4. This INDEMNITY & RELEASE shall be produced in both English and Japanese, and in case of discrepancy in the contents, English version shall be used.
5. I understand that this INDEMNITY & RELEASE will be governed by the laws of Texas; and that jurisdiction and venue for resolution of any dispute regarding this agreement shall lie in a Texas State Court in Travis County, Texas.
I, individually and on behalf of the Student agree to the terms and conditions above.
Date: ___________________________
Signature of Parent/Guardian ________________________________
Full name of Parent/Guardian ________________________________
免責 関 意書
オ スチン日本語補習授業校 運営委員長殿
校長殿
児童 生徒氏 ＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿ (幼稚園 小 中 年)
＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿ (幼稚園 小 中 年)
＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿ (幼稚園 小 中 年)
オ スチン日本語補習授業校(以 補習校)へ 表記児童 生徒 入学 通学 あた 記 意い
た ま
） 補習校 諸活動 い 何 スク 伴うこ をあ 了承
） 補習校 活動 関連 表記児童 生徒 怪 病気 事故 及び 表記児童 生徒
建物並び 学校備品破損 そ 直接 間接を問わ 補習校及びそ 教員 職員 運営委員
会 PTA及びそ パトロ そ 他 関係者(以 関係者 ) 過失 責任を問わ いこ 意
） 表記児童 生徒 け 病気 事故 際 必要 思わ 医療措置 い 関係者 委任
そ 全 費用 当方 負担
） こ 免責 関 意書 英文 和文 双方を作 内容 齟齬 あ 場合 英文 優先
） こ 意書 テキサス州法 管轄さ
記 サインを 記内容 意いた ま
署 年月日: ___________________________
保護者署 ________________________________
保護者氏 ________________________________
