I the parent and/or guardian of the applicant, hereby give my consent for him/her to participate in the 100 Black Men of Savannah, Inc. youth mentoring programs. I also agree that:1. Program staff, volunteers, Collegiate 100, and members of the Savannah 100, have my permission to provide Mentee reasonable first aid and transportation to a health care facility in the event Mentee needs emergency medical attention. I agree to release any records necessary for treatment, billing, referral or insurance purposes in the event Mentee is transported to a health care facility for emergency medical attention. 2. Pictures and video or audio recordings of Mentee participating in the Program are hereby released by me for use in appropriate news media (e.g. newspapers, radio, and television stations) and in the marketing materials for the Savannah 100 (e.g. website and brochure).3. In consideration of Mentee being allowed to participate in the program I agree on behalf of myself, Mentee, any other parent or guardian of Mentee, and any personal representative, agent, heir, successor or assign of the foregoing (hereinafter “Mentee’s parties”) to forever and irrevocably indemnify, hold harmless, waive liability, release and discharge Savannah 100, 100 Black Men of America, Inc., Program staff, and any corporate entities, officers, directors, members and employees related to any of the Program from any and all claims, d emands, causes of action, rights, costs and charges of whatever kind or nature, arising out of or related to any known or unknown, unforseen or unforseen bodily or personal injury, death, or property damage, resulting from Mentee’s voluntary participation in Program.4. In consideration of Mentee being allowed to participate in the Program, I covenant and agree on behalf of Mentee’s parties that Mentee’s parties will not sue Program parties for any claims for damages arising from or related to Mentee’s voluntary participation in Program. Consent, Release and Waiver Form (continued)5. Assumption of Risks: Engagement in Athletic Activities carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries and that participation in any physical activity involves peculiar risks that even when safety precautions are utilized, injuries can occur. I also understand that if I experience pain or physical discomfort during these activities I will decrease or stop participating. I am aware that personal health/accident insurance is my sole responsibility. I affirm that to the best of my knowledge, I do not have any medical condition or physical disability that will preclude my safe participation. 6. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in The Engagement of Athletic Activities and participation in attendant activities. I hereby assert that I knowingly assume all such risks. 7.I opt in to email and text communication with the opt out at any time. 8. The risk to have direct or indirect contact with individuals who have been exposed to and/or diagnosed with one or more communicable diseases, including but not limited to COVID-19 or other medical conditions, diseases, or maladies,and/or any mutation or variation thereof does exist and it is impossible to eliminate the risk that my child could become infected through contact with or close proximity to an individual with a communicable disease I hereby acknowledge that I have read this form and agree to waive certain legal rights by signing this Consent, Release and Waiver. *
