2019 Waiver and Release Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Missouri State Robotics Competition

Email *

Team or Business Affiliation (if any)

I am participating as a... *

Student

Alumni Mentor

Adult Coach/Mentor

Event Volunteer

Other:

Required

Waiver & Release

Read and check ALL of the following items for participation in the 2019 MSRC.

INJURY/DAMAGE RELEASE: I understand that participation in the Missouri Robotics State Championship is voluntary and that the activity carries some physical risk. I agree to assume the risk of any illness, injury, or damage to myself or personal property resulting from my participation in this activity. I hereby release and discharge Lindenwood University, Wentzville R-IV School District, Ratchet Rocker Robotics, Inc., The Lutheran Roboteers and STEM2U Youth Programs, their respective staff, volunteers, agents, sponsors, and affiliates from all liabilities claims, demands, controversies, damages, actions and causes of action, which result from or arise out of my participation in this activity.

CLAIMS RELEASE: I hereby release Lindenwood University, Wentzville R-IV School District, Ratchet Rocker Robotics, Inc., The Lutheran Roboteers and STEM2U Youth Programs, their respective staff, volunteers, family, agents, sponsors, and affiliates from all claims, including but not limited to claims for bodily injury, death, or property damage arising from my participation in the activity and the use of the Wentzville R-IV School District facilities by me. I assume responsibility for all liability in connection with such claims and agree to indemnify Wentzville R-IV School District, Ratchet Rocker Robotics, Inc., The Lutheran Roboteers and STEM2U Youth Programs, their respective staff, volunteers, agents, sponsors, and affiliates against any such claims and related costs, including claims by any minor which may be brought after attaining majority.

MEDIA RELEASE: Missouri State Robotics Championship participant irrevocably grant, at no cost to Lindenwood University, Wentzville R-IV School District, Ratchet Rocker Robotics, Inc., The Lutheran Roboteers and STEM2U Youth Programs, the absolute right and permission to use their name, voice, image, likeness, biographical materials worldwide, in perpetuity, in all forms of media now and forever known, including video footage, for the sole purposes of advertising, promoting, reporting, and disseminating information regarding the Missouri State Robotics Championship and its participants.

I have read and fully understand and accept each of the above conditions for participation in this activity.

I hereby represent and warrant by my signature, that I am 18 years of age or I am the legal parent or guardian of the participant listed below.

Participant Name *

I am 18 years or older. *

YES - participant signature required below

NO - parent/guardian signature required below

Signature

If participant is under the age of 18, a legal parent/guardian must sign below.

Participant E-Signature - Full Name *

I understand that checking this box constitutes a legal signature that I acknowledge and agree to the above terms.

Thank you!

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms