Release of Urban Life Training & Reality Assessment (ULTRA) Teen Choice, Inc. 


We/I the undersigned, individually and as parent(s) of _________________________________, who is a student of _____________________________ School, do hereby consent to our/my child's participation in the various activities of Urban Life Training & Reality Assessment (ULTRA) Teen Choice during the current school year and summer break. In giving this consent, We/I acknowledge and realize that activities planned and/or sponsored by ULTRA Teen Choice for the school year may include, by the way of illustration, weekend activities, such as bowling, ice skating, roller skating, cookouts, service projects and recreational activities. We/I consent to my child's participation in such activities or activities similar to them and as appropriate and necessary, agree that my child can be transported to and from such activities by organizers and volunteers of ULTRA Teen Choice. 

ULTRA Teen Choice will make effort to ensure that all activities are safe. However, We/l realize that there is the possibility that my child may be injured. In consideration of the time and effort provided by ULTRA Teen Choice in the planning, supervision, transportation, chaperoning, and administration of programs and activities sponsored by ULTRA Teen Choice, We/l hereby release and discharge the organizers and volunteer helpers of ULTRA Teen Choice, its agents, employees, and officers from any and all claims, lawsuits, demands, or damages which We/I might have (or which my heirs, executors, administrators or assigns might have or claim to have) against ULTRA Teen Choice for any and all personal injury or injuries to property caused by or arising out of my child's participation in the afore described activities in the current school year 

In the event that my child participates in activities of ULTRA Teen Choice, ULTRA Teen Choice may assume that my child participates with my knowledge, consent and permission. We/I expressly relieve ULTRA Teen Choice from informing me of my child’s participation in ULTRA Teen Choice activities. WE/I assume responsibility of knowing when and if my child is participating in ULTRA Teen Choice activities. . 

In the event that We/I wish to withdraw or nullify this release, We/I shall do so in writing to Urban Life Training, P.O. Box 353, Harpers Ferry, WV 25425. 
Telephone: 202-544-5081. Contact Person: Richard Urban, Executive Director. 

We/I have read this release and execute it voluntarily. 

Date:____________________ 

(Father)____________________________ 

(Mother)____________________________ 

Address________________________________________ 

_______________________________________ 

Telephone Number ________________________________________

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