1. I give permission for my child to attend Gloucester Biotechnology Academy’s STEM Enrichment Program.
2. Gloucester Biotechnology Academy agrees to notify the parent/guardian when the child becomes ill and the
parent/guardian will arrange to have the child picked up as soon as possible.
3. The parent/guardian agrees to inform Gloucester Biotechnology Academy within 24 hours or the next business
day after his/her child, or any members of the immediate household, has developed a reportable communicable
disease, as defined by the State Board of Health, except for life-threatening diseases which must be reported
4. The parent/guardian agrees to notify Gloucester Biotechnology Academy of any expected absences that the
child will have during the length of the program.
5. Gloucester Biotechnology Academy is not responsible for any loss or injury that might occur on the premises of
55 Blackburn Center.
6. I release and forever discharge the Gloucester Biotechnology Academy from any claim or action whatsoever
which arises or may arise on account of any first aid, medical treatment, or service rendered in connection with
activities conducted as a volunteer. I also agree to indemnify and hold-harmless the Gloucester Biotechnology
Academy against any such claim or action brought by any third-party (including any other family member) or, if
the volunteer is under 18 at the time the claim or action arises, brought by the volunteer.
7. Anyone under the influence of drugs and/or alcohol will not be permitted to participate. Smoking must be in
designated areas only.
8. I acknowledge that all the information on this form is truthful and accurate.