Digital Activity Liability Waiver

Youth Activities Release Form and Photo Release Form

Student(s)' First and Last Name(s): * Please enter your name.

Date of Birth of Student 1: *

Please enter valid date.

Date of Birth of Student 2:

Please enter valid date.

Date of Birth of Student 3:

Please enter valid date.

Parent/Guardian First and Last Name: * Please enter your name.

Please fill in Address: *

Please enter address.

Phone number: * Please enter your phone number.

Name and number of emergency contact: * Please enter your name.

Consent and Certification

I, being the parent or legal guardian of the youth(s) named above, a minor child under the age of eighteen years, do hereby consent to the participation of my youth in all the scheduled activities of Illinois Space Society at the event named Illinois Space Day (ISD), on the date of Saturday, October 6th 2018, including scientific demonstration and experiments. If I wish to revoke this consent for any reason, I will promptly notify the society in writing.

Medical Treatment Authorization

I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event that my child is injured or becomes ill. I authorize these persons listed above to act in my place to consent to all necessary and appropriate medical care if I am unable to be reached by the means listed above. I understand that the Illinois Space Society and The University of Illinois at Urbana Champaign shall have no responsibility to pay for medical treatment and related costs if said minor child is injured.

Your signature *

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Illinois Space Society Media Release Form

I hereby grant permission to the University of Illinois at Urbana-Champaign and the Illinois Space Society for the use of my photograph for educational, promotional, news, editorial and advertising materials in print and electronic/online formats. I understand that these images may appear in a variety of formats and media available now and in the future. I acknowledge the Illinois Space Society’s unrestricted rights to use and re-use my photograph in whole or in part and without restriction to changes or alterations. I hereby waive any right that I may have to inspect and approve the finished product or copy that may be used in connection with the images that the photographer has taken of me or the use to which it may be applied. I authorize the use of these images without compensation to me. I have read the above release and I am fully familiar with its contents. I further certify that I am either of legal age, or possess full capacity to execute the foregoing authorization and release.

Parent(s)/Guardian(s) First and Last Name(s): * Please enter your name.

Email: * Please enter your email.

Consent for Minors Under 18

I am the parent, guardian or supervisor of the minor named above and have the authority to execute the above release. I approve the foregoing and waive any rights in the premises.

Event

For the Illinois Space Society's Illinois Space Day 2018 on October 6th, 2018.

Your signature *

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Please sign here.

Digital Activity Liability Waiver- a popular online waiver among business owners