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8. READ THIS DOCUMENT COMPLETELY BEFORE SIGNING. ITS EFFECT IS TO RELEASE GUNNISON COUNTY’S SUBSTANCE ABUSE PREVENTION PROJECT (GCSAPP), ITS GOVERNING EXECUTIVE COMMITTEE, AND GUNNISON COUNTY FROM ANY LIABILITY RESULTING FROM YOUR CHILD’S PARTICIPATION IN THE ACTIVITIES DESCRIBED BELOW, AND TO WAIVE ALL CLAIMS FOR DAMAGES OR LOSSES AGAINST GCSAPP AND GUNNISON COUNTY WHICH MAY ARISE FROM SUCH ACTIVITIES.

12. Permission for Youth to Participate in Gunnison County’s Substance Abuse Prevention Project Events

14. I hereby give permission for ______________________ to participate in organized activities offered by Gunnison County’s Substance Abuse Prevention Project (GCSAPP) through Gunnison County. It is my understanding that my child will learn about substance use consequences, life skills and team building and will participate in activities that may be physically challenging. We also agree to follow the rules and regulations of GCSAPP. 

16. Release from Responsibility, Assumption of Risk, and Waiver

18. Student's First Name:*
19. Student's Last Name:*
21. Student's Preferred Name:
23. Gender:*
    -- Select One --FemaleMaleNon-BinaryOtherDecline to Disclose
24. Race:*
    -- Select One --American IndianAlaskan NativeAsian/ Pacific IslanderBlack or African AmericanHispanic AmericanWhite/ CaucasianMultiracial
25. Date of Birth:*
    Date of Birth:
27. School:*
    -- Select One --Crested Butte Middle SchoolCrested Butte High SchoolGunnison Middle SchoolGunnison High SchoolLake CityHomeschool/ Online
28. Grade Level:*
    -- Select One --6789101112
30. Mailing Address 1:*
32. Mailing Address 2:
34. City:*
35. State:*
36. Zip Code:*
38. 8th-12th Grader's Cell Phone Number for Drug Testing Notifications:

42. DATE(S) OF ACTIVITY (IES): 

    START DATE: September 1, 2025

    END DATE: August 31, 2026

44. Waiver of Liability, Acceptance of Risk and Exemption

46. I, the undersigned parent or guardian of the above named participant, hereby release and discharge, indemnify and hold harmless Gunnison County Substance Abuse Prevention Project, Gunnison County, and their members, officers, agents, employees, and any other persons or entities acting on their behalf, and the successors and assigns for any and all of the aforementioned persons and entities, against any and all claims, demands, and causes of action whatsoever, whether presently known or unknown, either in law or in equity, relating to injury, disability, death or other harm, to person or property or both, arising from my child’s participation in and/or presence at the above listed activities. 

    I acknowledge that I have been informed of the nature of the activities and that I am aware of the hazards and risks which may be associated with my child’s participation in the above-named activities, including the risks of bodily injury, death or damage to property which may occur from known or unknown causes. I understand, accept, and assume all such hazards and risks, and waive all claims against the State of Colorado and Gunnison County and other persons as set forth above. 

    I understand that I am solely responsible for any costs arising out of any bodily injury or property damage sustained through my child’s participation in normal or unusual acts associated with the above-named activities.

48. Consent for Media Release

50. I authorize GCSAPP the right to use my child’s, physical likeness and/or voice and/or visual imagery (photographs, moving footage, or other visual and/or audio media), interviews or other content provided to GCSAPP, in perpetuity and throughout the world. This material will be distributed at the discretion of GCSAPP to the media or shown in public venues for educational purposes. I represent that the consent of no other person, firm, corporation, or organization is required to enable GCSAPP to use my, or my child’s, likeness and/or voice and/or imagery as described herein, and that such use will not violate the rights of any third parties.

    I hereby certify and represent that I have read the foregoing and fully understand the meaning and effect thereof, and intend to be legally bound by this release. I am over 18 years of age and competent to contract in my own name, or on behalf of my minor child.

51. Initials:*

53. Consent for Release of Information and Permission 

55. l/we (parent/guardian) hereby authorize the Gunnison Watershed RE1J School District, Gunnison County Juvenile Services, and appropriate law enforcement authorities, to exchange student discipline information and progress information, which includes without limitation information regarding any violation of Gunnison Watershed RE1J School District rule or policy which is a violation of Choice Pass rule or policy, with GCSAPP for the sole purpose of managing student’s Choice Pass accessibility.

56. Initials:*

58. I/we (parent/guardian) hereby authorize RE1J School faculty and GCSAPP to pull my student from class for administering drug screens if/when my student should be selected for random monthly drug screens. I also authorize Drug Test West to administer random drug tests at a GCSAPP location after school hours.

59. Initials:*

61. I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read them, understand them fully, and agree to be bound by them. After careful deliberation, I voluntarily give my consent and agree to this Release from Responsibility, Assumption of Risk, and Waiver. 

63. I READ, UNDERSTOOD, AND AGREED TO THE INFORMATION PROVIDED IN THIS WAIVER:

65. Student's Digital Signature:*
66. Date:*
    Date:

70. I, (printed name) ________________________________________________, am the parent or legal guardian of the participant who has signed above. I have read and I understand the provisions of this document, I consent to the participant taking part in the activities described above, and I fully enter into and agree to the above Release from Responsibility, Assumption of Risk, and Waiver. 

72. Parent's First Name:*
73. Parent's Last Name:*
75. Email:*
76. Additional Email:
78. Phone:*
79. Additional Phone:
81. Is this your first year in Choice Pass?:*
    -- Select One --YesNo
83. Parent's Digital Signature:*
84. Date:*
    Date:
Leave This Blank:


88. Submit

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