• 2023 LYLC Student Registration Form

    Student Registration form for the 3rd Annual Regional Latino Youth Leadership Conference. 
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  • Parent information

  • Dalton State College - LATINO YOUTH LEADERSHIP CONFERENCE RELEASE OF LIABILITY AND ASSUMPTION OF RISK
    The following are the releases and agreements required by Emory University for participation in LYLC.
    I, as parent or legal guardian of this student, a minor (hereinafter "Student"), hereby grant the permission necessary to allow Student to participate in the Latino Youth Leadership Conference on March 16 2023(the “Program”). I acknowledge that Student is covered by an accident and health insurance policy and is physically and mentally capable of participating in the Program. I understand that Releasees (as defined below) do not guarantee the competency or mental or physical condition of any person associated with the Program, the physical condition of any facility or equipment used in connection with the Program, or the suitability of the Program for Student’s participation.

    I understand that there are inherent risks involved in participating in the Program, and I realize that participation in the Program is my and my Student’s choice. I am aware that, during the Program, certain risks and dangers may occur, including, but not limited to, the hazards of traveling by automobile, bus or other conveyance; the hazards of large groups of people; accident or illness; the forces of nature; all manner of foreseen and unforeseen bodily and personal injuries, including death; damage to property; and the consequences resulting therefrom.

    I understand that it is my and my Student’s responsibility to know what personal equipment is required (such as footwear and clothing) and provide the proper personal equipment for Student’s participation in the Program, and to ensure that it is in good and suitable condition. I agree to ask questions to make sure that Student knows how to safely participate in the Program activities.

    IN CONSIDERATION OF STUDENT BEING PERMITTED TO ATTEND AND PARTICIPATE IN THE PROGRAM, I ACKNOWLEDGE AND VOLUNTARILY ASSUME ALL RISKS OF DAMAGES OR INJURY, INCLUDING DEATH, THAT STUDENT MAY SUSTAIN OR THAT STUDENT’S PROPERTY MAY SUSTAIN WHILE I PARTICIPATE IN THE PROGRAM, ALONG WITH ANY TRAVEL TO OR FROM SUCH ACTIVITY OR THE PROVISION OF TRANSPORTATION TO OR FROM THE PROGRAM.

    In addition, I, on my own behalf and on behalf of my Student, our heirs, representatives, executors, administrators and assigns, for the sole consideration of Student being allowed to attend and participate in the Program, do hereby release, relieve, covenant not to sue and forever discharge, defend, indemnify and hold harmless, Emory University and its trustees, directors officers, agents, employees, students, members and volunteers, as applicable, (hereinafter collectively "Releasees") of any and from all claims, demands, rights, liabilities, losses, expenses, and causes of action (with the exception of gross negligence or willful misconduct) of whatever kind or nature including, but not limited to, negligence, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property, and the consequences thereof, including death, resulting from any participation in or in any way connected with arising out of or connected with the Program, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death) that Student may incur or sustain during the Program, all activities associated with the Program and while traveling to and from the site for the Program whether or not events during the Program actually occurs. I, ON MY OWN BEHALF AND ON BEHALF OF MY STUDENT, HEREBY WARRANT THAT I HAVE READ THIS RELEASE OF LIABILITY, COVENANT NOT TO SUE AND ASSUMPTION OF RISK (“RELEASE” OR “RELEASE OF LIABILITY”) IN ITS ENTIRETY AND FULLY UNDERSTAND ITS CONTENTS. I, ON MY OWN BEHALF AND ON BEHALF OF MY STUDENT, AM AWARE THAT THIS RELEASE OF LIABILITY RELEASES RELEASEES FROM LIABILITY AND CONTAINS AN ACKNOWLEDGEMENT OF MY VOLUNTARY AND KNOWING ASSUMPTION OF THE RISK OF INJURY OR ILLNESS. *

     

    Media Release:

    For good and valuable consideration herein acknowledged as received, I on my own behalf and on behalf of my Student, hereby grant to Releasees, and those acting with Releasees’ authority and permission, the irrevocable and unrestricted right and permission to create, use, re-use, publish and re-publish video recordings, audio recordings, photographs, or other media that contain or capture Student’s likeness or voice or in which Student’s likeness or voice may be included (the “Recordings”) in connection with any publication or materials relating to or serving the mission and goals of Releasees’, including advertisements, brochures, or other promotional materials. The Recordings may be used with or without Student’s name, and in any and all media now or hereafter known. I acknowledge and agree that Releasees’ own all right, title, and interest in and to the Recordings, including all copyrights therein and the full and unrestricted right to edit and modify the Recordings, and I hereby assign and agree to assign any such interest that I may own or control to Releasees. I also consent to the use of any printed matter in conjunction with the Recordings. I hereby waive any right I may have to inspect or approve the Recordings or any finished product or products incorporating the Recordings and any written or other print material that may be used in connection therewith, including print material containing my name. I acknowledge that nothing in this Agreement obligates Releasees or any third party to make any use of the Recordings. *

  • Medical Release

    In the event of any illness or injury, I authorize Releasees to obtain necessary medical treatment of Student and hereby, on my own behalf and on behalf of my Student, release and hold harmless Releasees in the exercise of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related bills that may be incurred on behalf of Student for any illness or injury that Student may sustain during the Program and while traveling to and from the site of the Program or events that taking place as a part of the Program. *

  • BY CLICKING BELOW, I, ON MY OWN BEHALF AND ON BEHALF OF STUDENT, HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ AND UNDERSTOOD THE ABOVE BEFORE SIGNING AND AGREE TO COMPLY WITH THE ABOVE PROVISIONS. I INTEND THIS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT, IF ANY PORTION OF THE RELEASE IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. I expressly agree that this Release shall be governed by and interpreted in accordance with the laws of the State of Georgia without regard to conflict of law principles.s.

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