Lord of the Bricks - Apply Online

Lord of the Bricks - Consent Forms

Consent forms are required for each competition season.
Season/Activity
PICTURE & VIDEO AUTHORIZATION

During the FIRST LEGO League/FIRST Tech Challenge seasons, pictures and videos will be taken of the students participating in the team activities or competition events, usually by the coaches, other parents, team members, reporters or other event personnel attending the functions. Photos and videos may be printed and/or released in newspapers, school publications, Lord of the Bricks Robotics Club website, Lord of the Bricks Robotics, Bucketbots, and/or HOMESCHOOL Resources Group website(s) and Facebook, presentations, club or team brochure, and email announcements, YouTube or any other media or publications.
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*
Please enter a valid phone number.
Consent*

Yes I/we give permission for my child’s picture and videos to be taken during the team meetings/ Functions/events and to be published as noted above.No; picture and video permission is not granted. (*Please note: team member may not be granted admittance onto competition floor.)
*For Participants under the age of eighteen (18) years listed above: I hereby consent and agree to the above as the Parent/Legal Guardian of (minor’s name), in which case

First NameLast Name
Participant Signature (Parent or Guardian Electronic Signature is under 18)*

Clear
Date

MonthDayYear
Date

CONSENT RELEASE, HOLD HARMLESS

This is a Consent and Release of Rights in favor of the Lord of the Bricks Robotics Club (LOTB) and its officers, coaches, advisors, mentors, team parents, volunteers, employees and assigns as well as entities designated and approved to assist LOTB in managing, contracting, sponsoring, hosting, conducting, evaluating or publicizing. As used below, “Participant” shall mean any individual, student, parents involved in a LOTB Event (team meetings, team activities, field trips, tournaments, events, and exhibitions, etc).
In consideration of the acceptance of my child and me participation in Lord of the Bricks Robotics Club, I agree to the following:

There are risks inherent in participating in Events, any team and/or Lord of the Bricks Robotics Club activities, including the risks inherent in the construction of robots and LEGO structures, as well as in working with electrical power, mechanical parts, machine and power tools, traveling to and from events, and participating in public competitions. These risks include the risk of bodily harm (including without limitation, death) and property damage. Being fully cognizant of the risks in participating in an Event, I hereby assume those risks and WAIVE ANY CLAIMS OR CAUSES OF ACTION which I may now or hereafter have against Lord of the Bricks Robotics Club arising out of my participation in any club meetings and activities, and I will indemnify and hold harmless against Lord of the Bricks Robotics Club any and all claims resulting from such participation.

I HEREBY RELEASE Lord of the Bricks Robotics Club and their respective coaches, successors, affiliates, team members and parents, licensees and assigns, from all claims, demands, liabilities, damages, costs and expenses attorneys’ fees, other professional fees and medical expenses, and any claims including, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever that I may now or hereafter have against Lord of the Bricks Robotics Club arising in connection with my participation in any Club activities.

In the event I should sustain injuries or illness while involved in an Event, I hereby authorize team coaches and team parents to administer, or cause to be administered, such first aid or other treatment and medications I may bring as may be necessary under the circumstances, to include treatment by a physician or hospital.

This Release shall be binding upon my heirs, personal representatives and assigns, and me and shall be governed by and construed under the laws of the State of Virginia, which shall be the venue for any legal action. This Release constitutes the entire agreement among the parties hereto with respect to the subject matter of this Release and supersedes any and all previous agreements among the parties, whether written or oral, with respect to such subject matter.

I understand that this form involves a release of legal rights.
Participant Student Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
*For Participants under the age of eighteen (18) years listed above: I hereby consent and agree to the above as the Parent/Legal Guardian of (minor’s name), in which case

First NameLast Name
Participant Signature (Parent or Guardian Electronic Signature is under 18)*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Lord of the Bricks - Consent Forms

PICTURE & VIDEO AUTHORIZATION

CONSENT RELEASE, HOLD HARMLESS