***I understand that not sending a transcript may disqualify me from the selection process.
I certify that my answers are true and complete to the best of my knowledge.
I, Name of Juvenile*, hereby acknowledge that I have voluntarily agreed to participate in the Kansas City Teen Summit (KCTS) STEM Program during the summer as specified by KCTS via calendars, letters, or emails in either Altheimer, AR; Pine Bluff, AR; Fayetteville, AR; Kansas City Region, Missouri and/or Kansas during the year of Year* .I understand that I am responsible for my own transportation and safety at all times. When activities are held in Fayetteville, AR, I also approve the University of Arkansas, Fayetteville STEM Academy to pick-up and drop-off my child to/from the program activities. I understand that KCTS assumes no responsibility or liability, nor does it grant any express or implied warrantied relating to the operation of any Third-Party Transportation Company used by the participant. I further acknowledge that participation in any activities or event could involve personal risks including COVID-19 or any other viruses, bodily injury, death and damages during my travel to these events.RELEASE OF LIABILITYAs consideration for being permitted to participate in the activity, I hereby agree that I, my heirs, executors, administrators, personal representatives, next of kin, spouse, and assigns, release, waive, discharge, covenant not to sue, indemnify, and hold harmless the mentors, volunteers, KCTS and board, the (Sixteenth Judicial Circuit, Jackson County, 1st-45th Judicial Circuit Missouri), the (1st through the 23th Judicial Circuit, and the Local District Court, University of Arkansas at Fayetteville, Washington County, Arkansas), (1st through the 45th Judicial Circuit, and the Local District Court, Missouri), and the State of Missouri or the State of Arkansas, their public officials, departments, officers, employees, agents, contractors and other affiliates, from all actions or claims now known, or which may become known in the future, for injury, death or damages which may result from my participation in this activity.ASSUMPTION OF RISKI realize that participation in the event may involve danger and acknowledge that I am voluntarily participating in this activity. I assume all risks involved whether they are known or unknown to me. I understand any such risks may include bodily injury, death, COVID-19 or other viruses, and damages. I further acknowledge that conditions may change over time during the course of the event. I and everyone in my traveling party, knowingly, willingly, and voluntarily assume any and all risks associated with traveling or transport to, before, during, and/or returning back from, the site of an Activity with KCTS, including but not limited to transportation used by a Third-Party Transportation Company.I acknowledge that my signature is required for participation in this event and affirm that I am at least eighteen (18) years of age or, if less than eighteen (18) years of age, have also obtained the signature of my parent or legal guardian. Additionally, I attest that I have read and understood the entirety of this Waiver and Release Agreement.Participant Name* Parent/Legal Guardian Name* Date*
I hereby grant permission to the rights of my pictures, image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
Photographic, audio or video recordings may be used and not limited for the following purposes:
By signing this release I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting.
I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.
There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.
By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.
If this release is obtained from a participant under the age of 18 then the signature of that participant’s parent or legal guardian is also required.