An and TSR Parental Waiver, Release of Liability, Transportation, Indemnification and Consent Form

Action Network Parental Waiver, Release of Liability, Transportation, Indemnification and Consent Form
I grant permission for my child, Childs name , to participate in activities with Action Network.
I am aware that pictures of my child may be taken while they are engaged in activities at Action Network. I am also aware that pictures may be posted to a website or published in other forms. The pictures will be used for the purpose of illustrating the activities at Action Network.

I, the undersigned, as the parent or legal guardian of the child named below, do hereby give my full consent and approval for my child to participate in Action Network activities and to be photographed for publicity and marketing purposes while at Action Network events and activities.

I further agree on behalf of myself and my child listed below, that I shall hold harmlelss and fully indemnify the parties hereby released from any and all claims, damages, costs including attorney fees, and causes of action which may arise from any cause of action made by me or by, through or no behalf of my child, even if the damages, injuries or death are caused in whole or in part by any of the persons or entities herby released.
I, guardians name would like my child to be transported to or from Action Network activities in the following manner:
I give permission for an Action Network Staff Member to drive my student in the Program Vehicle to and/or from Action Network activities.I give permission for another parent to drive my child/children in their personal vehicle to and/or from Action Network activities.
If you checked permission for another parent to drive your child in their personal vehicle, please clarify who has permission:
I acknowledge (a) that I have read (or have had read to me) each and every one of the provisions in this waiver, release of liability and indemnification agreement, (b) that I understand each of the provisions in this agreement and (c) that I agree to abide by them.
Name of parent or legal guardian

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of child

First NameLast Name
Signature Date
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Action Network Parental Waiver, Release of Liability, Transportation, Indemnification and Consent Form