Kick-Start: Summer to Success Registration

Parent/Guardian Information

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Babies Youth Children Empowerment, Inc., and all sponsoring parnters during the selected camp. In exchange for the acceptance of said child’s participation by Babies Youth Children Empowerment, Inc., and all sponsoring partners, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve, and hold harmless Babies Youth Children Empowerment, Inc. and all sponsoring partners 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 camp sessions.

In case of injury to said child, I hereby waive all claims against Babies Youth Children Empowerment, Inc., and all sponsoring parnters including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of injury inherent in all activities, including the premises. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named participant, 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 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 Babies Youth Children Empowerment. and its affiliates including 713Amazing, and Volunteers, to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the date for the Summer to Success Event.

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.

Publicity Release Form 

I, ________________________, give my permission to _____________________
_______________________ likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of Babies Youth Children Empowerment, Inc. (“BYCE”), 713Amazing Inc. and A. Randolf Institute activities. I agree that they have complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with the BYCE mission. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. I acknowledge that I will not receive any compensation, etc for the use of such pictures, etc., and hereby release BYCE and its agents and assigns from any and all claims which arise out of or are in any way connected with such use.
I have read and understood this consent and release.

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.