2016 Parental Consent and Photo Waiver

Parental Consent and Media Waiver 2016
To confirm your daughter's acceptance in the conference this Photo Release Form and Parental Consent Form must be completed no later than May 20, 2016.

Submission of this form implies that the undersigned parent/guardian has legal custody of the participant and consents to them participating in the 2016 Blueprint Conference for Middle & High School Girls at the Massachusetts Institute of Technology hosted by the National Alumnae Association of Spelman College, Boston Area Chapter ("the Organization"). With consent the undersigned gives permission for the participant to engage in all activities. In case of a medical emergency, the parent/guardian understands that every effort will be made to contact the emergency contact listed below. In the event that someone can not be reached, the parent/guardian hereby authorizes and consents to medical treatment and/or hospital care deemed necessary by licensed medical personnel on the staff of any licensed hospital.

Submission of this form confirms that the participant is allowed to participate in physical activities and confirms that the parent/guardian is fully aware of the risks and hazards connected with her participation and hereby elects to voluntarily have her participate in the activity, knowing that it may be hazardous to her or her property. PARENT/GUARDIAN VOLUNTARILY ASSUMES ALL RESPONSIBILITY FOR ANY RISKS OF LOSS , PROPERTY DAMAGE, OR PERSONAL INJURY, that may be sustained by her, or any loss or damage to property owned by her, as a result of being engaged in the activity, WHETHER CAUSED BY THE NEGLIGENCE OF THE ORGANIZATION OR ITS VOLUNTEERS, AGENTS, or otherwise.

The parent/guardian hereby RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Organization, the University, and their officers, agents, employees, or volunteers (hereinafter "RELEASEES") from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, that may be sustained by or to any property belonging to the participant, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES or otherwise, while participating in the activity. It is the express intent that this Release and Hold Harmless Agreement (hereinafter "agreement") shall bind the members of the participant and participant's family and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above named RELEASEES. The parent/guardian further agrees that this Agreement shall be construed in accordance with the laws of the State of Massachusetts. The parent/guardian hereby acknowledges that neither the Organization nor the sponsored Activity is affiliated with the University

The National Alumnae Association of Spelman College, Boston Area Chapter (NAASC-BAC) is requesting permission to use pictures from the 2016 Blueprint Conference for Middle & High School Girls at the Massachusetts Institute of Technology that will be taken of your child. Pictures and video will be used for promotional purposes, and may appear on websites, brochures, magazines, and other media types associated with NAASC-BAC and/or the Blueprint Conference for Middle & High School Girls. As such, your child's image will be available in the public domain.

Your submission of this form gives NAASC-BAC permission to use pictures of you/your child on www.naascboston.org, as well as make them available to other third party affiliate groups.

When NAASC Boston Area Chapter handles your form of communication, we understand and will respect your wish not to have your personal information (name, address, phone number, etc.) distributed, nor posted to their website.Therefore, we will not distribute, sell or otherwise provide your contact information to any other party.

Thank you,

NAASC Boston Area Chapter
Name of Parent/Guardian*

First NameLast Name
Relationship to Participant *
Name of Conference Participant *

First NameLast Name
Emergency Contact Number *

Area CodePhone Number
Parental Consent: *

I give consent for the above signed participant to attend and participate in the 2016 Blueprint Conference and accept the terms of this agreement.I DO NOT give consent for the above signed participant to attend the 2016 Blueprint Conference.
Photo Waiver:*

I give consent for the above signed participant to have pictures and video taken during the 2016 Blueprint Conference and the terms of this agreement.I DO NOT give consent for the above signed participant to have pictures or video taken during the 2016 Blueprint Conference.
Does your child have any food allergies*

YesNo
Please list any allergies
Does you child have any dietary restrictions? *

YesNo
Please list any dietary restrictions
Is your child able to participate in physical activities (i.e. beginners Zumba, dance, yoga)? If no, please explain.*
Should be Empty:

Parental Consent and Media Waiver 2016