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I understand that Amherst Leisure Services and Supplemental Education Department does not provide accident or hospitalization insurance for any program participants. Further I hereby waive and release any and all rights and claims for lost items or damages against LSSE and the Town of Amherst its representatives successors and assigns for any and all injuries suffered by my child or dependent while engaged in program activities. CHILD PERSONAL FACT SECTION 1. Child Preferred Name Age Siblings...
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