PARENTAL / GUARDIAN MINOR CONSENT, RELEASE AND WAIVER OF LIABILITY,
ASSUMPTION OF RlSK AND INDEMNITY AGREEMENT

FULL NAME OF MINOR: ___________________________________________D.O.B:_______________

IN CONSIDERATION of my minor child (named above) being permitted to participate in any way in an American Traffic Academy driving program and be physically present in any exercise areas associated with their Advanced Interactive Driver Education program, I agree to the following (Please initial next to each paragraph and sign at the bottom of the form):

__________(1). I know the nature of the course includes actual driving exercises and believe the Minor whose name is printed on this form to be qualified mentally and physically to participate in the Program. The staff of the American Traffic Academy will always conduct all driving programs in the safest manner possible. The instructors of the American Traffic Academy may terminate at their sole discretion, at any time and for any reason the remainder of a student’s program if that student demonstrates unsafe behavior which may endanger themselves or other people attending the driving program. No refunds or credits will be issued under any circumstance for any program terminated early for cause.

__________(2). I understand that driving is a potentially dangerous activity and participating in this driving school program has the potential of causing bodily injury. These risks and dangers may be caused by the minor child's direct actions, or inactions, the actions or inactions of others participating in the driving school program , the condition and layout of the premises and/or the equipment used in the event.

__________(3). I consent to the Minor's participation in the driving school program and/or entry into restricted areas and hereby accept and assume all such risks, known and unknown, and assume all responsibility for losses, costs and or damages following such injury, disability, paralysis or death, even if caused, in whole or in part, by the negligence of the others. I hereby agree not to sue the American Traffic Academy for any reason, for incidents occurring during these driving school programs.

__________(4). I the undersigned with a minor child participating in the driving course referred to herein, hereby releases the City of Henderson and Boulder City, their officers, agents and or employees form all liability demands or claims for loss, damage or injury resulting from participation in the above described driving event. I recognize and understand that the participant must be in good health to participate and represent that he or she is in good health.

__________(5). I have read this parental consent, release and waiver of liability, assumption of risk and indemnity agreement and fully understand its terms. I also understand that by signing this form I am giving up substantial rights. I am signing this form voluntarily and under no duress.

Parent / Guardian Signature: ___________________________________________Date:___________

Parent / Guardian Printed Name: ________________________________________________________

Parent / Guardian Tel. #: __________________________Alt #: _______________________________