Form Me1 12279115 - Minor Consent And Release Form

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FRC® Program -
Submit this form at the first 2016 MAR Competition event you attend.
Please PRINT in LARGE BLOCK LETTERS -This form will be scanned
Gender: (M) ___ (F)_____________________ Date of Birth [M/D/Y]_____________
Phone: Home/Cell _________________________ Email address: ___________________________________
Parent/Legal Guardian Name __________________________________________ Date of Birth [M/D/Y]___________
Address:____ _______ ______ ______________ City:_____________________ Sta te: __ __ ___ Z ip: ______________
Phone: Home/Cell _____________________ Email address: ____________________________ Gender: (M ) ___ (F) ____
1. BACKGROUND. This is a Consent and Release of Rights (“Release”) in favor of Mid Atlantic Robotics and its officers, directors,
employees, successors, assigns, volunteers and entities (“MAR”) who are working at the authorization or direction of MAR with
respect to participation in events and programs officially offered by United States Foundation for the Inspiration and Recognition of
Science and Technology (“FIRST”) and/or MAR, whether organized by FIRST, MAR, or by both - (collectively the “FIRST Event(s)”).
“Participant” means any person, under the age of eighteen (18) years of age, participating, attending, and/or involved, in any
capacity, in a FIRST Event.
2. AUTHORIZATION TO REPRODUCE PHYSICAL LIKENESS. (A). I acknowledge that FIRST Events are semi-public events that may be
attended by the members of the press, business corporations, and media (“Commercial Guests”) not under the control of MAR who
might photograph or videotape the event. As a matter of practice, MAR asks Commercial Guests to comply with the FIRST and MAR
policy of not printing a Participant’s name with his/her picture, and MAR asks them not to use images of Participants for commercial
purposes without obtaining specific written permission from the Participant’s parent/guardian. (B). In consideration of Participant
being allowed to participate in one or more FIRST Events, I hereby agree and grant to MAR the following: (1) the right to photograph,
videotape, or otherwise digitally collect Participant’s likeness, voice and sounds (as “Works”) during Participant’s presence at the
FIRST Event(s) and assign and grant all rights in these Works to MAR; and (2) the right to use or sublicense these Works and
Participant’s name, likeness and biography, in MAR’s discretion, in all media, for the promotion of MAR and its mission, program and
3. WAIVER AND RELEASE OF ANY FUTURE CLAIMS. (A). There are risks inherent in participating in FIRST Events, including risks in
the construction of robots, as well as in working with electrical connections, traveling to and from events, and participating in public
competitions. These risks include the risk of bodily harm (including without limitation, death) and property damage or loss. (B).
Being fully cognizant of the risks of participating in a FIRST Event, I, and Participant, hereby assume those risks. Except to the extent
due to the gross negligence or willful misconduct of MAR, and to the fullest extent permitted by applicable laws, in consideration of
Participant being allowed by MAR to participate in the FIRST Events, I HEREBY WAIVE AND RELEASE ANY CLAIMS OR CAUSES OF
ACTION that I or the Participant may now or hereafter have against MAR arising in connection with or relating to my participation
in any FIRST Event or arising from unofficial MAR programs and events offered by others. I, and the Participant, hold harmless
MAR, against any and all claims resulting from such participation, including, without limitation, claims for compensation,
defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.
4. AUTHORIZATION FOR MEDICAL TREATMENT. In the event Participant should sustain injuries or illness while involved in a FIRST
Event, I hereby authorize MAR to arrange for emergency first aid, medications, and/or hospital treatment.
5. CHOICE OF LAW. This Release shall be binding upon my, and Participant’s, heirs, personal representatives and assigns, and shall
be governed by and construed under the laws of the State of New Jersey, which shall be the venue for any legal action. This Release
constitutes the entire agreement among the parties hereto with respect to the subject matter of this Release and supersedes any
and all such previous agreements among the parties, whether written or oral.
6. CONFIDENTIALITY. MAR strongly believes in the confidentiality of all contact information. MAR promises that it will not rent or
sell this contact information. However, I hereby grant to MAR the right to use the personal contact information provided here to
support and promote MAR, and its research, program evaluation, alumni efforts and/or other outreach activities.
7. SIGNATURE OF PARENT/LEGAL GUARDIAN. I understand that this form involves a release of legal rights. For the Participant
under the age of eighteen (18) years listed above, I hereby consent and agree to the above.
Parent or Legal Guardian Signature
Date _____________________________
ME1 12279115v.3 rev 12/03/2013 EWP


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