Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities and/or field trips offered by Liberty Village Project. In exchange for the acceptance of said child’s candidacy by Liberty Village Project, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Liberty Village Project and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected activities and/or field trips. In case of injury to said child, I hereby waive all claims against Liberty Village Project including all coaches, chefs, teachers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the activities, field trips, and/or the event. There is a risk of being injured that is inherent in all youth activities and field trips. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Age-Appropriate Immunization Requirements

I hereby confirm that I have had, or am willing to have, my child immunized with the Covid-19 vaccine and to Maryland state standards or provide documentation supporting Exemption from Immunization.

Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named student or athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Liberty Village Project and its affiliates including Directors, Coaches, Chefs, Teachers and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Photograph/Media Consent and Release

I consent and authorize LIBERTY VILLAGE PROJECT to take photographs or motion pictures of myself (and/or my child); or to produce videotapes, audiotapes, closed circuit television programs, web casts, or other types of media productions that capture myself (and/or my child’s), voice, and/or image (any of the foregoing types of media are called the “Materials” in this Consent and Release form).

I authorize LIBERTY VILLAGE PROJECT to copyright the materials, and I authorize LIBERTY VILLAGE PROJECT to use, reuse, copy, publish, display, exhibit, reproduce, license to third party, and distribute the materials in any educational or promotional materials or other forms of media, which may include, but are not limited to university publications, catalogs, articles, magazines, recruiting brochures, websites or publications, electronic or otherwise, without notifying me. I agree to these items to be used up to 99 years after the initial date of use. I agree that I am participating on a voluntary basis and I will not receive any payment from LIBERTY VILLAGE PROJECT for signing this release or as a result of any publication of the materials.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.