Fillable Form Me1 12279115 - Minor Consent And Release Form printable pdf download

MID ATLANTIC ROBOTICS

MINOR

2016

CONSENT AND RELEASE FORM

FRC® Program -

Season

Submit this form at the first 2016 MAR Competition event you attend.

Please PRINT in LARGE BLOCK LETTERS -This form will be scanned

Minor’s

Team

Name

Gender: (M) ___ (F)_____________________ Date of Birth [M/D/Y]_____________

Address:_______________________________________________________________

City:_________________________________State:____________Zip:_____________

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

events.

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

Form Me1 12279115 - Minor Consent And Release Form

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