Parental Consent Form

Parental Consent and Liability Release Form

 

I give my child permission to attend and participate in all activities sponsored by the ATLANTA BRICK CO from this day forward.

LIABILITY RELEASE: In consideration of ATLANTA BRICK CO allowing the above participant to partake in ATLANTA BRICK CO activities, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless ATLANTA BRICK CO, its staff, founders, volunteers, counselors, chaperones, cooperating businesses or service providers under contract with ATLANTA BRICK CO from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned and the participant while involved in the activities. We (I) the parents or legal guardian(s) of this participant hereby grant our (my) permission for the participant to participate fully in all ATLANTA BRICK CO activities.

Furthermore, we (I) [and on behalf of our (my) minor participant(s)] hereby assume all risk of accidental

personal injury, sickness; death, damage and expense as a result of participation in recreation and work activities

involved therein.

Further, authorization and permission is hereby given to said ATLANTA BRICK CO to furnish any necessary transportation, food and lodging for this participant as required for the ATLANTA BRICK CO activities. The undersigned further hereby agree to hold harmless and indemnify said ATLANTA BRICK CO for any liability sustained by said ATLANTA BRICK CO as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.

MEDICAL TREATMENT PERMISSION IN THE CASE OF AN EMERGENCY: We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment or hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provision of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all cost and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

PHOTOGRAPHY: I hereby consent to my child being interviewed or videotaped at events sponsored by

ATLANTA BRICK CO. Furthermore, I consent to the publication, exhibition or reproduction of any such interview material, photograph or videotapes to be used for public relations, news articles or telecasts, education, advertising, research, inclusion on the ATLANTA BRICK CO website, facebook, fundraising or any other purpose. I, the undersigned, also consent that I will not seek compensation for my child’s participation here.