I, the undersigned, being the parent or legal guardian Child's First Name*Child's Last Name*, a member of the Rhosebud Club of the Upsilon Sigma do hereby consent to the participation of my child in Rhosebud activities sponsored by the Upsilon Sigma of Sigma Gamma Rho Sorority, Inc. I certify that my child is physically fit and adequately prepared to participate in these activities as provided in the Rhosebud Health and Authorization Form. I understand that I am responsible for ensuring that my child is prepared to participate in each activity as determined by the Upsilon Sigma of Sigma Gamma Rho Sorority, Inc. This may include, but is not limited to, payment of fees and attending any preparation meetings. I also understand that I am responsible for ensuring that my child behaves appropriately during these activities. I further understand that, if in the opinion of the Upsilon Sigma of Sigma Gamma Rho Sorority, Inc., or adult-in-charge (“Leader”), my child is not behaving appropriately, I may be asked to pick-up my child early from the activity at my own expense, and that it is at the Leader’s discretion whether or not to refund any fees that I’ve paid for this activity. I understand that my child may not participate in activities if she appears to be ill. I further understand that if my child appears to be ill when she arrives at an activity or becomes ill during an activity, I will be asked to pick-up my child early from the activity at my own expense, and that it is at the Leader’s discretion whether or not to refund any fees that I’ve paid for this activity.

I,   First Name*   Last Name* (PRINTED NAME OF PARENT/GUARDIAN) certify that I am the legal parent/guardian for   First Name*   Last Name* (Child's Name)and on behalf of myself, my heirs, assigns and all other persons or entities claiming by, under or through me, represents covenants and agrees that I will not hold or seek to hold Sigma Gamma Rho Sorority, Inc., its officers, directors, regions, chapters, members, affiliates, employees, agents or representatives responsible for any liability resulting from my child’s participation in activities sponsored by the Rhosebud Club of Upsilon Sigma (“Rhosebud Club”). I further waive and release any and all rights and claims against the aforementioned parties for any injury or loss suffered while participating in the Rhosebud Club. For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following: I hereby grant to the Rhosebud Club, and others working for the Rhosebud Club or on its behalf, and each of its respective licensees, successors and assigns (each a “Releasee”), the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my child’s name, picture, likeness and voice (including any video footage of the same) (collectively, “Media”), or to refrain from so doing, anywhere in the world, by any persons or entities deemed appropriate by Rhosebud Club, for any purpose (except defamatory) including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any manner or media whatsoever (whether known or hereafter devised) including, without limitation, on the internet, in print campaigns, via radio and via television. I agree that I have no interest or ownership in any of the Media. I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation or right of publicity) arising out of any use, alteration, blurring, illusionary effect or use in any composite form of my child’s name, picture, likeness and voice. I agree that nothing in this Release will create any obligation on the Rhosebud Club to make any use of the Media or the rights granted in this Release. I hereby release and hold harmless Releasees from any claim for injury, compensation or negligence resulting or arising from any activities authorized by this Release and any use of the Media by the Rhosebud Club.