NCSO Consent forms - Buies Creek (Div. C) Regional
Holly Springs High School
Team *
Student First Name *
Your answer
Student Last Name *
Your answer
Parent/Guardian's Name(s) Please list all guardians *
Your answer
Parent/Guardian Contact Numbers - list all that apply *
Your answer
Parent/Guardian emails (Please list all emails and whom they belong to.) *
Your answer
Photo Consent *
In consideration for being allowed by NC State to participate in the NC Science Olympiad program (hereinafter “Program”) the undersigned custodial parent/guardian hereby agrees as follows: *
Please read and check all the boxes before submitting.
I do hereby affirm and acknowledge that my child is participating in the Program for his/her own personal benefit, and have been fully informed of the inherent hazards and risk to them associated with this activity including property damage, falls, contact with other participants, motor vehicle accidents, sprains, and other personal injuries. I accept and assume responsibility for all risks, known and unknown, involved to my child and their property in the aforementioned activity, and I voluntarily authorize my child’s participation in reliance upon my own judgment and knowledge of my child’s experience and capabilities.
I understand that the determination of my child’s ability to participate in the Program should be made by my child’s physician if necessary. I understand that I need the approval of a physician if I am uncertain as to his/her physical fitness for the rigors of this Program. I understand that I may be required to seek approval from a physician if there is a health or safety question relative to my child’s condition before being allowed to participate in the Program. In addition, I give permission to any doctor, hospital, or other medical facility to release confidentially to the treating physician(s) for my child any information they may have concerning his/her medical condition and their professional contact with him/her for treatment purposes. I hereby grant my permission for such diagnostic, therapeutic, and operative procedures as deemed necessary for my child. A photocopy of this permission is to be considered valid as the original. I further understand that treatment for any medical problems my child may suffer is my responsibility and will be paid by me and/or covered by my insurance.
I shall indemnify and hold harmless NC State, Campbell University, its trustees, officers, employees and agents from any liability, losses, costs, damages, claims or causes of action of any kind or nature whatsoever, and expenses, including attorneys fees, arising from or proximately caused by my child’s participation in this Program, including any travel. I further agree to accept and assume for myself, my assigns, executors, and heirs any and all such risks and losses that may occur.
I have read the Program’s rules and regulations (found here: and hereby accept the regulations of the Program described therein. I understand that the Program has the authority to establish and enforce other regulations in addition to these.
By putting your name in the blank, you are electronically signing saying "I have reviewed this information. I understand that my child is responsible for following the guidelines and expectations established. *
Your answer
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