By submitting this form, I certify that I am the parent/legal guardian of the student and give permission for my student to participate in all portions of the program. The student is not currently using any medications that induce drowsiness or otherwise cause impairment. If the student has epilepsy, the student has been seizure-free for at least 6 months and documentation of such is readily available. If the student has a hearing or visual impairment, the student will wear (if needed) any eyewear or hearing apparatus required to operate a motor vehicle safely. The student will not have used alcohol or any drug in the 24 hours preceding participation in the program. I understand that although the program is intended to improve driver skills and that CCC will take reasonable safety precautions, there are both known and unanticipated risks which could result in severe personal injury, death, or property damage, as well as liability for myself and the student relating to the student's operation of a vehicle. I release, waive, and indemnify CCC from and against any and all claims and liabilities. If a collision occurs for which the student is in any way responsible, I understand and agree that I will be responsible for all damages resulting therefrom.