Open ReeOrganized opened 3 years ago
Parent/Guardian Consent Form (from ChickTech, we can modify)
Your child has expressed interest in attending our ChickTech High School Program.
As part of the ChickTech program, your child will be participating in activities that may include soldering, working with tools, and building computers and other electronic devices. Please provide us with the information requested below!
This also allows consent of your child to be photographed and shared on ChickTech social media.
If you're 18 or over, please fill out this form acting as your own parent/guardian. Registration ID Your Child's First Name Your Child's Last Name Primary Contact Name The person who should be contacted first in an emergency! Primary Contact Relationship Primary Contact Email Address Primary Contact Phone Number Can we text this number with event updates and reminders? Secondary Contact Name Secondary Contact Relationship Secondary Contact Email Add only if you'd like this person to receive reminders and updates as well! Secondary Contact Phone Would this person like to receive text updates and reminders as well? Does your child have a medical condition or disability we should be aware of? Please describe, including medications and special accommodations that are needed. In case medical information is required in an emergency, please provide your family doctor's name and phone number. Is your family currently eligible for lunch assistance? Is English the primary language spoken in your home? If you have any translation needs/requests, please note them in the next field. Any other special needs we should be aware of? Please note any translation needs/requests here! Would you be willing to help drive other students to/from event(s)? We'll contact you with more information if this is needed! Thank you for your help in reducing barriers for other students! Future Opportunities I would like to be contacted by ChickTech and its partners about future event, internship, academic, and employment opportunities. Parent Agreement I, the parent or legal guardian of the Student listed above, hereby give my consent to the Student’s participation in ChickTech. I understand that the Student may be transported to and from the ChickTech events and that the Student may be engaged in activities such as soldering, working with tools, computers or other equipment. The Student will be supervised by ChickTech volunteers during the scheduled ChickTech events.
In consideration of the permission granted to me and to the Student for the Student to participate in ChickTech, I, the undersigned parent or legal guardian, to the extent permitted by law, do hereby:
(1) assume any and all risk and liability for all losses, damages, damage to property, injuries or death to the Student which may arise in connection with travel to/from or participation in ChickTech sponsored by ChickTech or its affiliates, and hereby, for the Student and for myself and our heirs, executors, administrators, successors and assigns, do release and discharge the ChickTech and each of its affiliates, officers, directors, employees, volunteers, predecessors, successors, representatives and assigns (collectively “ChickTech”), from any and all claims, actions, and liabilities arising from or relating to with travel to or participation in activities, programs or functions of ChickTech, and;
(2) grant permission for videographic, photographic or audio recording of the Student’s participation in the activities, programs or functions of ChickTech, and for the use of such recordings by or with the consent of ChickTech for promotional and educational purposes in perpetuity.
This consent form will remain in effect for all ChickTech events occurring from the time of your signature.
I, the undersigned, have carefully read the foregoing consent and release form and know and understand the contents thereof. I sign this consent and release voluntarily and with knowledge of its significance, and intend to be legally bound thereby.
[Please type your name below to sign this form.] Meredith College Photography Release * By signing below, I, the undersigned, hereby irrevocably grant to Meredith College, its officers, employees, trustees, faculty, licensees, successors and assigns (collectively “Meredith”) the right to
(1) take or use any and all photographic images, video or audio recordings and/or multi-media in connection with ChickTech Raleigh Durham that may contain my name, image, likeness, voice, and statements (collectively, “Photos”); and
(2) use, re-use, copy, modify, adapt, distribute, publish, display, perform, exhibit, create derivative works from and otherwise exploit such Photos in perpetuity, in any media, by any means, methods and technologies now or hereafter known, including by posting on the Internet, for Meredith’s educational, marketing, promotional, and other business purposes.
I understand and agree that the Photos may be used with or without identifying me, or any other form of attribution and that I will receive no payment or other consideration for posing or allowing Meredith to use the Photos.
I hereby voluntarily waive any and all rights to inspect or approve use, distribution, transfer, display or other exploitation of the Photos, and to any royalties, proceeds or other benefits derived from the Photos.
I hereby voluntarily release and discharge Meredith from, and shall neither sue nor bring any other proceeding against Meredith for, any claim or cause of action, for defamation, violation of any moral rights, invasion of right to privacy, publicity or personality or any similar matter, or based on or relating to any use, publication, distribution or other exploitation of the Photos.
This release is effective on the date written below and will remain in effect indefinitely unless otherwise agreed in writing by Meredith and me.
If you are (i) under 18, (ii) under 19 and a resident of Alabama or Nebraska, (iii) under 21 and a resident of Mississippi, or (iv) under the age of majority in your country of residence, a parent or legal guardian must also read and sign this release.
By signing below, I represent that I have read and understand the contents of this Release.
[Please type your name and date below to sign this form.]
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We will want to have insurance for volunteers working with the kids. This org might not need to handle that if the tournament or the host have taken care of this. If we have to get our own insurance, background checks will likely be required.