Pursuant to California Civil Code Section 25.8, I hereby authorize the Director or Nurse of Camp Dream Street to consent to any X-ray, examination, anesthetic, medical or surgical diagnosis or treatment, or hospital care to be rendered to me or my said child/ward under the general or special provisions of the Medical Practice Act, or to consent to any X-ray examination, anesthetic, dental or surgical diagnosis or treatment, or hospital care to be rendered to me or my said child/ward by a dentist licensed under the provisions of the Dental Practice Act. This authorization shall be effective whether such diagnosis, treatment or care is rendered at the office of said physician or dentist, at a hospital, at Camp Dream Street, or elsewhere, and shall remain effective while I am or my said child/ward is enroute to or from or involved or participating in any program or activity at Camp Dream Street, unless earlier revoked by me in writing and delivered to the Director.
On my own behalf and on behalf of my child/ward, I hereby expressly release, discharge and hold harmless Camp Dream Street and the Dream Street Foundation, and their respective agents, employees, officers, and representatives, of and from any liability or responsibility arising from any damage, loss, or injury sustained by me or my child/ward while traveling to or from Camp Dream Street, while attending Camp Dream Street or any trips or other activities sponsored by the Dream Street Foundation, or while staying in any accommodations provided or arranged by Camp Dream Street or the Dream Street Foundation, other than any such liability or responsibility which may arise as a result of their gross negligence or willful misconduct. This release includes within its scope any damage, loss or injury sustained as a result of any ordinary negligence, whether active or passive on the part of Camp Dream Street, the Dream Street Foundation, or any of their agents, employees or representatives.
The foregoing release is to be construed in accordance with the laws of the State of California. It is intended to release claims, which are as yet unknown. Accordingly, I hereby wave, on my own behalf and on behalf of my child/ward, the provisions of the California Civil Code Section 1542 which provides:
“A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.”
