I agree that the name, voice, likeness, image and/or work of    Student First Name*   Student Last Name*   may be used for publicity and/or informational purposes 

by LYS and/or by members of the media as permitted by LYS.

SignatureI understand, agree and appreciate that the Louisiana Youth Seminar may involve a variety of rigorous physical activities including, but not limited to: in strenuous physical activities with LYS, which may include, by way of example only and not of limitation, walking to events, participating in skits, participating in long and late hours of activities, and unsupervised downtime. The degree and extent of participation remains my choice, based on what I can comfortably and willingly risk. However, it is up to me to inform the appropriate authority of my choice, and tell the authority if I perceive pressure to participate. Yet there is a risk, both known and unknown, which must be assumed by me, that I may suffer serious emotional or physical injury or disability, or even death.

SignatureI It is herewith acknowledged and agreed that by my participation in the
Louisiana Youth Seminar that I understand that such activity is inherently dangerous regardless of
safety precautions to reduce the risk, and that I HAVE VOLUNTARILY AND KNOWINGLY ASSUMED
ANY AND ALL RISKS, both known and unknown, including that I may suffer serious emotional or
physical injury or disability, or even death, as a result thereof, and that I assume full responsibility for
my participation. I further ASSUME ALL LIABILITY for my own actions and any damages or injuries
caused by the same. In the event that I observe and perceive any unusual or significant hazards during
my presence or participation, I will immediately notify the appropriate authority and remove myself from participation in this activity.

Signature   In accordance therewith, in consideration of my participation in the Louisiana Youth Seminar I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby RELEASE AND HOLD HARMLESS, Louisiana State University, Board of Supervisors of Louisiana State University and Agriculture and Mechanical College its agents, officers, employees, participants, volunteers, and all other persons or entities acting in any capacity on its behalf, used to conduct the event (hereafter referred to collectively as the "Releasees"), with respect to any and all injury, disability, death and/or loss or damage to person or property, including if such injury or damage is due to the negligence of Releasees and its employees. Should Releasees, or anyone acting on thier behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold such harmless for all fees and costs. I certify that I have adequate health insurance to cover any injury or damage that I may sustain while participating, or I agree to bear the costs of such
injury or damage to myself. I further certify that I am in good health, and I have no medical or
physical conditions that could interfere with my safety in this activity, or I am willing to assume and
bear the costs of all risks that may be created, directly or indirectly, by any such condition. I understand and acknowledge that it is my personal responsibility to obtain my own medical advice and evaluation to determine whether I should participate in the Louisiana Youth Seminar .In case of an emergency, this consent also authorizes the release of this form and all medical and accident report forms to emergency personel, doctors, hospitals, insurance companies, my employers, other person or entities deemed appropriate.

I hereby certify that I am the adult parent or guardian of   First Name   Last Name, a minor child under the age of eighteen years (“registrant”), and I consent to his/her participation in activities with the Louisiana Youth Seminar (“LYS”), on the campus of Louisiana State University (“LSU”).

I understand and acknowledge that I am fully aware of and assume the risks (including but not limited to the risk of serious bodily injury and/or illness, property loss or damage) of registrant’s participation in strenuous physical activities with LYS, which may include, by way of example only and not of limitation, walking to events, participating in skits, participating in long and late hours of activities, and unsupervised downtime. I recognize my responsibility to ensure that registrant participates only in those activities for which he/she is physically capable of performing.  

I understand that LYS shall have no responsibility to pay for medical treatment and related costs if registrant is injured. Additionally, I understand and acknowledge the importance of full participation in all events scheduled for the week of LYS, and that in the event registrant is unable to participate meaningfully such events, LYS may require me to pick up registrant before the LYS program is complete. I further understand and acknowledge that in such event, no refunds will be available, despite registrant not having completed the full week of LYS programming.

Knowing the risks described above, and in consideration for LYS accepting the registrant for its program and activities, I agree, personally and on behalf of the registrant named above, to assume all the risks and responsibilities surrounding registrant’s attendance and participation in the LYS program. To the fullest extent allowed by law, I hold harmless, release, discharge, and agree to indemnify LYS and its Board of Directors members, Executive Committee, staff, volunteers, affiliates, vendors, organizations, sponsors and the LSU Board of Agricultural and Mechanical College, its directors, officers, employees, agents and volunteers from and against any present or future claim, cause of action, loss, or liability for injury to person or property, resulting from any cause whatsoever, and regardless of fault, which said registrant may suffer or for which said registrant may be liable to any other person, related to said registrant’s participation in LYS, its program and activities, and/or transportation to or from same, which participation and/or transportation I hereby authorize.

I hereby grant permission to an attending physician to render any medical and/or surgical treatment deemed necessary to relieve pain and/or preserve the life and/or health of registrant. I understand that reasonable efforts will be made to avoid accidents and prevent illness, but I agree that LYS will not be responsible or liable for any illness or injury. I certify that the above history is true and complete to the best of my knowledge.

I am at least eighteen years of age and have carefully read and freely signed this Liability Waiver and Release Form. I understand and agree that no oral or written representations can or will alter the contents of this document. I agree that this agreement shall be governed by the laws of the State of Louisiana (excluding conflict of laws principles).