(We), as parent(s) or guardian(s) of the minor, do hereby, for my/our self, heirs, executors and administrators, remise, release and forever discharge the Spina Bifida Association of Greater New England, all of the officers, employees, and agents of each of the foregoing acting officially otherwise, from any and all claims, demands, actions or causes of action on account of referred. I hereby certify that the minor is my/our child.
In case of accident, permission is granted for emergency treatment to be administered. It is further understood that I/we will assume full responsibility for any such action, including payment of costs. I/we hereby advise that any allergies or special considerations for the above named minor has been disclosed during this registration process.