Career Connections Waiver Form

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This form is for parents or guardians of students that will be participating in the Allegheny Intermediate Unit's Career Connections program.

Name of Student *

School District *

Program student applied for: *

Architecture

Associated Artists - Art Careers

Future Teachers Academy

Theatre at Warp Speed!

Opera

RxPlore Pharmacy

Writing for Publication

Zoo Animal Care

Parent Email Address *

Waiver

The undersigned, while participating in the Allegheny Intermediate Unit Career Connections Program, agrees to abide by all rules and safety requirements for the site to be visited, and assumes all risks arising from or related to his or her participating in the program. The undersigned, and any parent or guardian, if a minor, hereby waives and releases the Allegheny Intermediate Unit from any and all claims and causes of action against the aforementioned for any damage or injury to the person or property of the undersigned, or parent or guardian, alleged to have been caused by any act.

This release and waiver shall apply at all times that the undersigned is away from his or her residence for the purpose of participating in the Allegheny Intermediate Unit Career Connections Program.

Agree

Photograph Release

The Allegheny Intermediate Unit is permitted to display and/ or share electronically via the Internet and/or in other displays and/or in the news media photographs of me taken in conjunction with my participation in the AIU Career Connections program.

By signing this release, I understand and consent that photographs of me may be displayed by the Allegheny Intermediate Unit or by the news media. I also understand that the Allegheny Intermediate Unit's display of photographs of me on the Internet and/or in other displays and/or in the news media will allow the photographs to be viewed by the general public. *

Agree

Disagree (If this is chosen the student will not be included in any photographs during the program.)

Emergency Contact and Phone Number *

Please list any special needs relative to physical capabilities, dietary restrictions, or taking medications that you may have:

Please enter your First and Last Name, as parent or guardian signature, confirming your answers for your child. *

Submit

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