NAME OF CAMP/PROGRAM:___

PARTICIPANT NAME:___

5. PROPERTY DAMAGE

I agree to be financially responsible for damages to Kentucky State University property caused by negligent, reckless, or intentional acts of my child.

6. GOVERNING LAW

I understand that any legal claim arising from participation in the program shall be governed by the laws of the Commonwealth of Kentucky.

ACKNOWLEDGMENT

I certify that:

• I am the parent/legal guardian of the participant listed above;
• I am at least 18 years of age;
• I have read and understand this Residential Summer Camp Release of Liability;
• and I voluntarily agree to its terms.

Parent/Guardian Signature ___

Date _____

Kentucky State University is an equal opportunity provider.