PARENTAL REQUEST TO PARTICIPATE RELEASE, MEDIA RELEASE, AND WAIVER AGREEMENT
I am the parent or legal guardian of the above-named
Student/Participant and am requesting that my child participate in the
following Omega STEM program (herein collectively referred to as “Activity”)
being sponsored by Omega Psi Phi Fraternity, Inc.
In consideration of permission being granted for my child to
participate in this Activity and for other valuable consideration, the receipt
and sufficiency of which are hereby acknowledged, I am entering into this
Release and Wavier Agreement, which extends to the following persons and
entities, as well as their trustees, officers, directors, board members,
agents, employees, volunteers, contractors, representatives, successors, or
assigns, individually and in any capacity or relationship with or for any
other:
Omega Psi Phi Fraternity, Inc
My child’s enrollment or participation will or could subject
my child to numerous dangers or risks of personal injury, even fatal, as well
as other injuries or damages, including without limitation:
1. major injuries such as: broken bones, cardiac
arrest/heart attack, eye injury or loss of sight, drowning, concussion, joint,
ligament or back injuries and heat exhaustion, burns;
2. minor injuries such as: strains, sprains, bruises,
scratches, cuts and abrasions.
3. online risks such as: data mining, phishing, viruses,
malware, data breach of online information cyberbullying, exploitation,
victimization, cyber stalking, online grooming, cyber predators, image
replication
I have explained these risks to my child. These risks and
dangers have been considered and, relying on my own judgment, I have
voluntarily chosen to allow my child to participate and assume all such dangers
and risks. I certify that my child is in suitable health and capacity which
allows my child’s enrollment or participation in the Activity.
I knowingly, voluntarily, and for adequate consideration
release and waive, and further agree to indemnify, hold harmless, and reimburse
each and all of those persons and entities referenced above, from an against
any claim which I, my child, any other parent of my child, any relative or any
next of kin of my child, or any other person, firm or corporation now or
hereafter may have or claim to have (whether known or unknown, seen or
unforeseen, directly or indirectly, or within or without the control of those
persons and entities), for or on account of any losses, damages, personal
injuries, pain and suffering, death, property damage, or contract claims
resulting from, or arising out of, during, or in connection with my child’s
enrollment or participation in such Activity, or the ownership, operations, use,
maintenance, or control of any vehicle, equipment or goods provided or used in
connection with such Activity, or in any way connected with or arising out of
instruction, training, emergency care, or operations incidental to such
Activity. To the extent that any damages arising out of bodily injury to
persons or damage to property are caused or result from the sole negligence of
any person or entity referenced above, then, I do not agree to release, waive,
indemnify, hold harmless or reimburse any such person or entity.
If any emergency medical procedures or treatment are
required during the Activity, I consent to the Activity supervisor undertaking,
arranging for or consenting to the procedures or treatment in his, her or their
discretion and that I will be responsible for any and all expenses or fees
related to my child’s medical care. I acknowledge that neither Omega Psi Phi
Fraternity, Inc. nor any of the named entities shall be liable for any such
fees or expenses under any circumstances.
Further, I hereby certify that my child is covered by an
accident and health insurance policy that will be in effect at any time my
child is participating in an Activity on the campus or, sponsored by, or
related to Omega Psi Phi Fraternity, Inc
In regard to any photographs, video tapes, motion pictures,
recordings, or any other reproduction of my image or my child’s image
(hereinafter collectively known as “Images”) which is taken of me or of my
child or in which I may be included with others during the course of my
participation in this program, I hereby grant Omega Psi Phi Fraternity, Inc
permission to use such Images in any media now or hereafter known for any
legitimate purpose whatsoever, and to use my name or my child’s name in
connection therewith if Omega Psi Phi Fraternity, Inc so choose.
I hereby grant permission to the chapter, Omega Psi Phi Fraternity and its affiliates to use my likeness, image, and voice (collectively referred to as "Media") in any and all of its publications and promotional materials, including but not limited to print, online, and social media.
I understand and agree to the following terms and conditions:
1. I hereby waive any right to inspect or approve the finished product wherein my Media appears. I also waive any claims to royalties or compensation arising from the use of the Media.
2. I understand that my Media may be used in various promotional materials and for promotional purposes, including but not limited to brochures, websites, social media, advertisements, and news releases.
3. I release the Chapter and Omega Psi Psi Fraternity Inc. and its representatives from any and all claims, demands, or causes of action that I may have now or in the future relating to the use of my Media.
This Release and Waiver Agreement shall be construed to be
as comprehensive as is allowed by law. Each provision herein is severable, so
that should any provision or portion of such provision be held invalid, the
remainder of this Release and Waiver Agreement shall not affect the
enforceability of any other portion. This Release and Waiver Agreement shall
not establish a legal or other relationship between or among those released
which does not in fact exist. Nothing in this Release and Waiver Agreement
shall constitute a waiver of any legal defense available to any released party
herein, including sovereign immunity. The validity, interpretation, and effect
of the Release and Waiver Agreement shall be governed by the laws of the State
of Ohio.
