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2025 CLHS Prom Waiver Only Form

This form is meant for Prom attendees that had a ticket purchased for them by their date. All attendees must have a completed waiver form submitted to attend the dance. Confirm with your date that a ticket has been purchased on your behalf.

Please complete the form below. Required fields marked with an asterisk *. 

OFF CAMPUS PERMISSIONS SLIP INFORMATION:

The following individual (“Participant”) desires to participate in the following Event (Wings of Wonder Dancing with Butterflies Prom on Friday, May 16th at Lux Vita in Tomball) hosted by Concordia Lutheran High School (the “School”):

In consideration of Participant being allowed to participate in the Event noted above, we, the Participant and the Parent(s) and/or Legal Guardian(s) of the Participant, jointly and severally, do hereby grant the following releases and permissions:

 

Permission: We, the Parents/Guardians of Participant, hereby consent to and give permission for Participant's participation in the above-referenced, school-related, voluntary Event, and understand that the participation of Participant in such Event involves a certain element of risk, including serious injury and, although unlikely, the possibility of death. We have reviewed the detailed description of the Event above and understand the various types of things involved in the Event that could potentially elevate the risk of serious injury or even death.  We are comfortable in assuming full and complete responsibility for, and risks of, death, personal or bodily injury, disability, and/or property damage resulting from, in connection with, or in any way related to, Participant’s participation in the Event.

 

Release and Waiver: We, intending to legally bind ourselves, our child, and all of our respective guardians, heirs, executors, personal and legal representatives, estates, beneficiaries, administrators, successors and assigns (all of the foregoing, collectively the “Releasors”), do hereby WAIVE, RELEASE AND DISCHARGE, AND COVENANT NOT TO SUE, Concordia Lutheran High School, and its officers, directors, trustees, shareholders, owners, managers, partners, employees, staff, volunteers, chaperones, agents, and supervisors and their successors and assigns (collectively the “Releasees”) from any and all liability and/or claims, suits, damages, injury, disability, death, costs and expenses, whether arising before, during or after the Event, and whether caused by the sole or joint negligence, gross negligence, or tortious act or omission of the Releasees or any third party (collectively the “Claims”). Notwithstanding anything herein to the contrary, the willful misconduct of the Releasees is expressly excluded from the scope and application of this Release and Waiver.  The Releasors hereby knowingly and voluntarily waive, to the fullest extent permitted by law, the benefits of any statute, law, rule, or common law which may limit the scope of this Release and Waiver.

 

We also hereby agree to INDEMNIFY, DEFEND AND HOLD HARMLESS Concordia Lutheran High School and its officers, directors, trustees, shareholders, owners, managers, partners, employees, staff, volunteers, chaperones, agents, and supervisors and their successors and assigns from any and all claims, liabilities and costs asserted by or on behalf of us or any of our legal representatives, heirs, successors and assigns within the scope of the release above.  In consideration of Participant having the privilege of participating in the Event and acknowledging that Participant and we accept responsibility for his/her actions at all times, we hereby assume the risk of, and release and hold harmless Concordia Lutheran High School from, any and all injury to or damage by Participant during the Event.  We agree to be financially responsible for any and all damages, costs or fees for which the School may be liable as a result of the conduct of Participant.     

 

In the event that this Release and Waiver is found to be invalid, unenforceable, or void, in whole or in part, for any reason, then the Releasors acknowledge and agree that in no event, including, without limitation, the negligence or gross negligence of the Releasees, or any of them, shall the Releasees’ aggregate liability to Releasors or any other person exceed any applicable insurance limits, and in no event shall Releasees, or any of them be liable to any person for special, incidental, consequential, or punitive damages or for any indirect damages such as, but not limited to, exemplary damages or lost earnings, lost revenues or loss of consortium, or companionship (even if the Releasees have been advised of the possibility of such damages) whether based upon statute, contract, tort, negligence, strict liability, or otherwise.

Notwithstanding any provision herein to the contrary, this Release and Waiver does not release, is not intended to release, and does not in any way apply or relate to the release and/or discharge of any claims Releasors may have against any person and/or party other than the Releasees.

 

The Releasors represent and warrant to the Releasees that (i) all of Participant’s living parents and/or legal guardian(s), as applicable, have duly signed the Release and Waiver (unless the School has granted a specific written exception due to unusual circumstances), and (ii) Participant has no medical condition (physical or mental) which would or could impact on the Releasees allowing Participant to participate in the Event and that the Participant is physically able to participate in the Event, and (iii) the Participant is not taking any herbal or medicinal supplement or prescription that could impact Participant’s participation in the Event. 

 

Participant Conduct Obligations:  We also agree that Participant is expected to abide by all School rules and direction from faculty, administrators, coaches, volunteers, or chaperones during such Event and that Participant’s failure to do so will be justification for termination of participation in the Event and Participant will be sent home at his/her Parent/Guardian’s expense without refund for the payment made to participate in the Event (if any). 

 

Transportation:  Participants are expected to provide their own transportation to and from the event. No transportation will be provided by the school. The school shall not be liable for any injuries that occur to Participants riding in vehicles that are not provided by the school. 

 

Medical Authorization:   We authorize the School, at its discretion and our expense, to obtain medical service, surgical care, or treatment for Participant in the event of an emergency.  This authorization is given with the understanding that the School will attempt to notify the Participant’s Parent/Guardian or emergency contact in the event of an emergency if possible, in the School’s judgment. We confirm that it is our desire that Participant be furnished with such medical care, surgical care or treatment services as soon as reasonably possible after the need arises.  We hereby release and hold the School harmless from any liability which might arise from the giving of such consent.  We agree to reimburse the School for any medical expenditure made on Participant’s behalf.  

 

Consent to On-Site Medical Care:   We hereby authorize the School to supply medical care as needed for the Participant.  This will include the administration of emergency medications and those prescribed by a licensed practitioner for the Participant.  We authorize the School to perform appropriate minor medical care, as determined by those School employees supervising the Event.  We hereby release and hold the School harmless from any liability which might arise from the provision of such medical care.

 

We are aware of, and understand fully, the potential risks involved in connection with the Event and that we may choose to NOT allow Participant to participate in the Event at our sole discretion. We understand that the description of the inherent risks associated with the Event, as set forth herein, is not complete and that other unknown or unanticipated risks may arise.  We agree that the Participant’s participation in the Event is purely voluntary. 

 

Furthermore, we acknowledge that we have received the opportunity (and been strongly encouraged) to review this Consent, Waiver, and Release with an attorney, that we have carefully read and fully understand the contents of this Consent, Waiver, and Release and have asked and received answers to all questions we may have, and that we have duly executed this Consent, Waiver, and Release freely and voluntarily, intending and agreeing to be fully bound by the terms hereof.

Is the Participant a current CLHS Student?*
Answer required for "Is the Participant a current CLHS Student?"

REMINDER: If CLHS Students are bringing a Non-CLHS Student Date, they MUST also complete and turn in the Non-CLHS Student Dance Form available for download and return to the school office by Monday, May 12. Visit this link to download and print off the Non-CLHS Student Prom Dance Form: www.clhs-tx.org/prom 

 

Confirmation Email