Parent Permission Form & Waiver
PERMISSION TO ATTEND/PARTICIPATE IN
G3 Robotics Team ACTIVITIES at MIDTOWN HIGH SCHOOL AND
RELEASE AND WAIVER OF CLAIMS
Parents: Read the nine stipulations below and sign below to indicate your understanding and agreement.
1. By signing below, I warrant that I am the parent and/or legal guardian of the minor child attendant or participant (the “Minor”), and on behalf of the Minor, I agree to the terms and conditions set forth herein. I hereby grant permission for the Minor to participate in activities at Midtown High School and other locations related to the G3 Robotics Team (the “Robotics Team”), the FIRST Robotics Competition and other science or robotics-related programs, meetings, or events the Robotics Team chooses to become officially involved in, collectively referred to herein as the “Activities”. As used below, “Participant” shall mean any individual, student, mentor, teacher, or volunteer involved in such activities.
2. I acknowledge and agree, on behalf of the Minor and myself, being fully cognizant of the risks, that participation in the Activities, even as a spectator involves risk of bodily injury and damage to or loss of property. In consideration of the Atlanta Public School System (APS), specifically Midtown High School, and the team mentors allowing the Minor and/or me to participate in the Activities, I hereby, for myself, my spouse (if any), and for the Minor, to the fullest extent permitted by law, release and hold harmless the Atlanta Public School System, Midtown High School, the Robotics Team, its mentors, and each of their parents, ultimate parents, subsidiaries, affiliates and related entities, and each of their present and former directors, officers, employees, agents, contractors, representatives, insurers, licensees, successors, and assigns (collectively, “Parties”), from any and all rights, claims, demands, liabilities, losses, damages, expenses, costs and/or actions (including without limitation, attorneys’ fees) which I, my spouse, the Minor, or anyone claiming on behalf of or through me, my spouse, or the Minor may now have or hereafter acquire in connection with my and/or the Minor’s participation in the Activities, including, without limitation, any bodily injury, personal injury (including without limitation, death), loss of consortium or property damage that I or the Minor may incur or which may arise or result from my or the Minor’s participation in the Activities. Except to the extent due to the gross negligence or willful misconduct of the Robotics Team’s officials or mentors, to the fullest extent permitted by applicable laws, I hereby waive any claims or causes of action which I may now or hereafter have against the Robotics Team, its mentors, APS or other affiliated Parties arising out of my participation.
3. In the event the minor or I should sustain injuries or illness while involved in an Activity, I hereby authorize the Robotics Team and/or its mentors to administer, or cause to be administered, such first aid or other treatment and medications as may be necessary under the circumstances, to include treatment by a physician or hospital of the Robotics Team’s or its mentors’ choice. I give permission for a licensed medical authority (EMT, RN, LPN) to administer first aid or a doctor of medicine selected by the Robotics Team, its mentors or APS personnel to hospitalize, secure proper treatment for, and to order medicine, injections, anesthesia, surgery, or x-rays following a medical emergency. I also give permission for personnel to provide transport to a medical facility for the purpose of obtaining medical care following an injury or medical emergency. I will not hold the Robotics Team, its mentors, or APS responsible for any injury or repercussions from medical attention.
4. Further, on behalf of the Minor and myself, I hereby grant Parties the irrevocable, perpetual, worldwide and unlimited right, but not the obligation, to make and exploit both visual and/or audio recordings and still images of the Minor and/or me and to use the name, voice, likeness, and/or biographical information of the Minor and/or me (collectively “Likeness”) as the Robotics Team desires, forever and throughout the world in connection with any of the Parties’ programming, promotional/marketing materials, and/or other media (collectively, the “Media”) and for the purpose of advertising, marketing and/or promoting the Parties, any of the television networks or websites owned, operated and/or controlled, in whole or in part, by any of the Parties, without further compensation to me or any limitation whatsoever. In granting this license, I understand that the Robotics Team is not under any obligation to exercise any of their rights, licenses, and privileges herein granted. Each such photograph and videotape shall be a work for hire and the Robotics Team or its designated agent shall be deemed the owner of any copyright and/or trademark rights therein (and all applications, registrations and renewals resulting therefrom). If, however, the work is deemed not to be a work made for hire by a court of the competent jurisdiction, then this Consent and Release To Produce Physical Likeness (“Release”) shall constitute an irrevocable assignment by the Participant of the worldwide copyright in the work to G3R and potentially through their agreement to the FIRST organization. It is a G3R and FIRST policy not to print a minor’s picture accompanied by his/her name unless specific permission from his/her parent or guardian is obtained.
5. On behalf of the Minor and myself, I understand that the Parties reserve all rights to develop any ideas and programs conceived independently or with third parties, without obligation to the Minor or myself, even if such ideas or programming are similar or identical to the ideas included by Minor or me during and/or related to the Activities. On behalf of the Minor and myself, I agree that the rights granted hereunder shall include the irrevocable, perpetual, worldwide and unlimited right of the Parties to edit, telecast, cablecast, rerun, record, publish, reproduce, use, license, print, distribute, or otherwise exploit the Media, including, without limitation, the Likeness, in any manner and in any medium or forum whether now known or hereafter devised, in whole or in part, without further compensation to the Minor or me.
6. I warrant that I am of legal age and that I have every right to contract in my own name and on behalf of the Minor.
7. I agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Georgia. If any provision of this agreement shall be held void, voidable, invalid or inoperative, no other provision of this agreement shall be affected as a result thereof, and the remaining provisions of this agreement shall remain in full force and effect as though such void, voidable, invalid or inoperative provision was not included herein
8. I acknowledge that some Robotics Team activities will occur at locations other than Midtown High School and may require the Minor to travel from the school grounds. I hereby grant permission for the Minor to be transported to these official events in privately owned vehicles, owned and operated by an adult Mentor of the team or any other duly authorized adult who is supporting Robotics team activities. Such authorization would come from the Robotics team sponsoring teacher, Midtown’s principal, APS representatives, or the Robotics team mentors. I agree that any claims for bodily injury, personal injury, or property damage or loss arising from any event associated with this transport will be limited to the personal liability insurance coverage provided by the adult providing said transportation and to hold harmless the Robotics Team, the other Mentors, and APS.
9. I understand that this form involves a release of legal rights.
