TechGirls - Chinese American Parent Association of Howard County(CAPA)
After-School STEM workshops for 4th and 5th grade girls

Release and Waiver of Liability and Consent of Photo Use Form
After-school Program/Event: Achieve Success Together   - TechGirls
Time Period: July 1, 2023 – June 30, 2024
Sign in to Google to save your progress. Learn more
Email *
CAPA-HC Release and Waiver of Liability and Consent of Photo Use
In consideration of being permitted to participate CAPA AST Program, THIS RELEASE AND WAIVER OF
LIABILITY (the “Release”) is given by ________________________________ (participant's name) and/or
his/her parents or legal guardian(s) in favor of the Chinese American Parent Association of Howard County
(CAPA), a non-profit organization operated by a group of volunteers, and its board members, volunteers,
administrative officers, employees and any other associated personnel including owners or landlords of the
premises utilized by the CAPA for activities performed (“CAPA personnel”).
Participant acknowledges, agrees, and represents that participant enters this agreement freely and voluntarily
with all information fully disclosed to the CAPA.
Participant does hereby give this Release under the following terms:
1. Waiver and Release. Participant fully understands that participant’s participation in the program/event
involves risks, and does hereby release and forever discharge and hold harmless CAPA and/or the CAPA
personnel from any and all liability, claims, and demands that participant may have with respect to the
program/event.
2. Media/Photographic Release. Participant does hereby grant and convey unto the CAPA all rights, title, and
interest in any and all photographic images and video or audio recordings made by CAPA during the
participant’s activities with respect to the program/event.
PARENTAL PERMISSION
In consideration of the opportunity afforded my (our) child to participate CAPA program/event, I (we) give my
(our) permission for my (our) child to participate in the program/event, and I (we), on behalf of my (our) child
and myself (ourselves) agree to the terms and conditions set forth within this agreement Without limiting the
generality of the foregoing, I (we), on behalf of my (our) child and myself (ourselves), do hereby release and
forever discharge and hold harmless CAPA and/or the CAPA personnel from any and all liability, claims, and
demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my
(our) child’s activities with respect to the program/event.


Participant print name: *
Which grade is participant at for 2023-24 school year? *
Please type in school/location where participant joins TechGirls after-school program *
Participant's parent or legal guardian name: *
Participant's parent/legal guardian's email
*
Participant's parent or legal guardian phone: *
Participant's parent or legal guardian: 
Please read waiver and sign your FULL NAME below:

By signing this document, I indicate I have read and agree with CAPA-HC waiver information as shown above.
*
Date Signed:
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy