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Girls Conference Parental Forms 2016-2

The document is a parent/guardian consent form for a minor to participate in the 2016 Blueprint Conference for Middle & High School Girls hosted by the National Alumnae Association of Spelman College, Boston Area Chapter at the Massachusetts Institute of Technology. It provides consent for medical treatment in case of emergency and releases the organization from liability. It also includes a media release allowing the use of photos and videos of the participant for promotional purposes.

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Faith Marie
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56 views3 pages

Girls Conference Parental Forms 2016-2

The document is a parent/guardian consent form for a minor to participate in the 2016 Blueprint Conference for Middle & High School Girls hosted by the National Alumnae Association of Spelman College, Boston Area Chapter at the Massachusetts Institute of Technology. It provides consent for medical treatment in case of emergency and releases the organization from liability. It also includes a media release allowing the use of photos and videos of the participant for promotional purposes.

Uploaded by

Faith Marie
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PARENT/GUARDIAN CONSENT FORM

I, the undersigned have legal custody of the participant named below, a minor, and have
given my consent for _____________________________________to participate in the 2016
Blueprint Conference for Middle & High School Girls at Massachusetts Institute of
Technology hosted by the National Alumnae Association of Spelman College, Boston Area
Chapter. I give my permission for the participant to engage in all activities.
In case of a medical emergency, I understand that every effort will be made to contact me or
the emergency contact listed below. In the event that someone cannot be reached, I hereby
authorize and consent to any x-ray, examination, anesthetic, surgical diagnosis, medical
treatment and/or hospital care which is deemed advisable by, and rendered under the
general or special supervision of any licensed medical personnel on the staff of any licensed
hospital.

Emergency Contact Details:


Name:

________________

Relation to Participant:
Home Phone Number:

__ ______________
________________

Mobile Phone Number: ________________

Health Concerns:
Does your child have any food allergies?
If yes, please explain:

Yes

No

_______

Does your child have any dietary restrictions? Yes

No

If yes, please explain:


Can your child participate in physical activities (i.e. beginners Zumba, cardio)?
Yes No
If no, please explain:

PARENT/GUARDIAN RELEASE FORM


My child is a participant in the 2016 Blueprint Conference at Massachusetts Institute of
Technology sponsored by National Alumnae Association of Spelman College, Boston Area
Chapter (the Organization). I am fully aware of the risks and hazards connected with her
participation in the conference (Activity), and hereby elect to voluntarily have her participate
in the Activity, knowing that the Activity may be hazardous to her or her property. I
VOLUNTARILY ASSUME ALL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY
DAMAGE, OR PERSONAL INJURY, that may be sustained by her, or any loss or damage to
property owned by her, as a result of being engaged in the Activity, WHETHER CAUSED BY
THE NEGLIGENCE OF THE ORGANIZATION OR ITS VOLUNTEERS, AGENTS, or
otherwise.
I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Organization,
the University, and their officers, agents, employees, or volunteers (hereinafter
RELEASEES) from any and all liability, claims, demands, actions, and causes of action
whatsoever arising out of or related to any loss, damage, or injury, that may be sustained
by or to any property belonging to me, WHETHER CAUSED BY THE NEGLIGENCE OF THE
RELEASEES or otherwise, while participating in the Activity. It is my express intent that this
Release and Hold Harmless Agreement (hereinafter Agreement) shall bind the members of
my family, and shall be deemed as a RELEASE, WAIVER, and DISCHARGE AND
COVENANT NOT TO SUE the above-named RELEASEES. I hereby further agree that this
Agreement shall be construed in accordance with the laws of the State of Massachusetts. I
hereby acknowledge that neither the Organization nor the sponsored Activity is affiliated with
the University.

Parent/Guardian Signature: ____________________________________________


Date: _______________________________________________________________

MEDIA RELEASE FORM


The National Alumnae Association of Spelman College, Boston Area Chapter
(NAASCBAC) is requesting your permission to use pictures and video from the 2016
Blueprint Conference for Middle & High School Girls at Massachusetts Institute of
Technology that were taken of you/your child. These pictures will be used for
promotional purposes, and may appear on websites, brochures, magazines, and
other media types associated with NAASCBAC and/or the Blueprint Conference for
Middle & High School Girls. As such, your/your childs image will be available in the
public domain.
Your signed consent gives NAASCBAC permission to use pictures and video of
you/your child on www.naascboston.org, as well as make them available to other
third party affiliate groups.

Sign below if you are in agreement:


I __________________________________________ agree to allow pictures of
me/my child, ___________________________________ to be used by NAASC-BAC
for purposes they deem appropriate including, but not limited to those listed above.

Parent/Guardian Signature: ____________________________________________


Date: _______________________________________________________________

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