Epicenter - A safe place for middle school students to hang out after school on Tuesday and Thursday until 4:45.
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Epicenter - A safe place for middle school students to hang out after school on Tuesday and Thursday until 4:45.

Epicenter - A safe place for middle school students to hang out after schoo...

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Sheridan Community Center

300 East 6th Street

Sheridan, IN 46069

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LIABILITY RELEASE FORM

Release of All Claims

In consideration for being accepted by SYAP - Epicenter for participation durin the 2016-17 school year, we (I), being 21 years of age or older, do for ourselves (myself) (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless Sheridan Youth Assistance, Inc. and the staff and Board of Directors, and any and all volunteers, thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above-described trip or activity.

Furthermore, we (I) [and on behalf of our (my) child-participant if under the age of 21 years] hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.

Further, authorization and permission is hereby given to said organization to furnish any necessary transportation and food for this participant.

The undersigned further hereby agree to hold harmless and indemnify said organization, its directors, employees and agents, for any liability sustained by said organization as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.

(If the participant has not attained the age of 21 years):

We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said trip or activity, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including buy not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.


We offer a safe and consistent environment for your children to be a part of…students must be Sheridan residents, have a completed form on file and obey the rules set forth by the Epicenter to continue to attend and participate. Our guidelines are:

  • Have fun
  • Respect others and their property
  • Honor others
  • Participate, don’t alienate
  • Be honest
  • No profanity allowed
  • No cheating. Period.
  • No drugs or alcohol before attendance
  • Strive for excellence
  • No Purple---not the color, but no touching (no boy/girl girl/girl, boy/boy)
  • No gossip or name calling

I have read and understand the guidelines of Epicenter and request that my son/daughter be admitted. I agree that Sheridan Youth Assistance (SYAP) will not be responsible for any accident to the boy/girl while at Epicenter. I give my consent for photographs, in which my son/daughter may appear, to be used by SYAP for records and publicity. I also understand that if my son/daughter does not conduct themselves according to the guidelines set forth by Epicenter, that they could face dismissal from the program. I also understand that transportation to and from the School and the Community Center is my responsibility.

It is very important that it is known that after the first incident of your student not being picked up on time, the student will be sent to the library 15 minutes after the closing time of our activities or the Epicenter if not picked up.

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Sheridan Community Center

300 East 6th Street

Sheridan, IN 46069

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