Texas Association for College Admission CounselingMotivate Me Conference 2017

Parent Waiver

Your child has registered for the Texas Association for College Admission Counseling’s (TACAC) Motivate Me Conference.

As part of your child’s registration, you must complete and electronically sign the Parent/Guardian Permission and Waiver Form below.

The form will require you to provide your contact information, an emergency contact person, insurance policy information, medical and allergy information, any medications, as well as agree to policies and waivers.

The permission and waiver form must be submitted by the registration deadline, Saturday, July 15, 2017, for your child to be included in the program.

If you have any questions, contact us at tacac.motivateme@gmail.com.

Best Regards,

The Motivate Me Conference Staff Texas Association for College Admission Counseling

Page 1 of 6

Parent/Guardian Permission Waiver Form

Child/Ward’s name:

Parent/Guardian Information

Parent/Guardian Name:

Email:

Phone Number:

Alternate Phone:

Address (street, street 2, apt, city, state, zip)

Student Participation and Permission

1. Parent or Legal Guardian Consent

I agree to allow my child or ward named above to participate in the TACAC Motivate Me Conference.

2. Loss of Personal Property

My child/ward shall be solely responsible for any/all damages, loss by theft or otherwise of personal property whether such property belongs to the student or to others.

3. Code of Conduct

TACAC and the Motivate Me Conference have adopted a Student Code of Conduct. Conference participants are expected to comply with the Student Code of Conduct and all federal, state and municipal laws.

4. Signature Statement

I have read this permission form including the statements relative to Student Travel, Loss of Personal Property and established Standards of Conduct, and I hereby grant permission for participation of my child/ward, in TACAC Motivate Me Conference.

*Required:

I understand and agree to the terms.

Page 2 of 6

Participation Agreement, Release and Acknowledgement of Risk

In consideration of TACAC Motivate Me Conference, and individually, the Texas Association for College Admission Counseling (TACAC), any of the host institutions, and its trustees, agents, officers, volunteers, participants, employees and all other persons acting in any capacity on their behalf (hereinafter collectively referred to as “Motivate Me”), I hereby agree to release and discharge Motivate Me conference on behalf of myself, my children, my parents, my heirs, assigns, personal representatives and estate as follows:

1. I expressly agree and promise to accept and assume all of the risks existing in the activities of Motivate Me. My child/ward's participation in these activities is purely voluntary, and I elect to allow my child/ward to participate in spite of any risks.

2. I further agree to hold harmless Motivate Me, its officers, directors, agents, instructors, and associates from all manner of third party actions or claims and agree to reimburse any claims against Motivate Me and their officers, directors, agents, employees, instructors, and associates arising by reason of my child/ward's participation this program.

3. Should Motivate Me, or anyone acting on its behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

4. I certify that I and/or my child/ward has adequate insurance to cover any injury or damage my child/ward may cause or suffer while participating, or else I agree to bear the cost of such injury myself. I further certify that my child/ward has no medical or physical conditions that could interfere with my safety in the activities of Motivate Me or its program, or else I am willing to assume and bear the cost of all risks that may be created, directly or indirectly, by such a condition.

5. By signing this document, I acknowledge that if anyone is hurt or if property is damaged during my child/ward's participation in the activities, I may be found by a court of law to have waived my right to maintain a lawsuit against TACAC or Motivate Me on the basis of any claim from which I have released them herein.

6. I hereby grant TACAC and Motivate Me permission to use, reproduce, or distribute any photographs, digital images, films, videotapes, and/or sound recordings of my child/ward during his participation in Motivate Me for use in materials that may be created.

*Required:

I understand and agree to the terms.

Page 3 of 6

Medical and Allergy Information

TACAC, Motivate Me conference, and the hosting college do not provide health and accident insurance for conference participants. It is recommended that parents check their current insurance policies. Any injuries incurred will be covered under the parent’s/student’s insurance coverage.

Any medication that is required must be in its original container and must be accompanied by a note from the doctor indicating the need for it and the dosage of the prescription for our files. The label is not adequate.

Emergency Contact Name:

Relation to Participant:

Emergency Contact’s Cell Number:

Emergency Contact Alternate Number:

Primary Care Physician’s Name:

Physician’s Office Number:

Medication:

My child is NOT currently taking any medication.

My child IS currently taking medication(s).

Medical Conditions:

Asthma

Allergies

Other (please specify, list and describe For example: diabetes, epilepsy, migraines, heart condition, etc.)

My child has no known medical conditions

Page 4 of 6

Authorization for Emergency Medical/Dental Care

I give my child/ward permission to participate in TACAC's Motivate Me Conference. I agree that any injuries incurred will be covered under my own insurance coverage.

I understand that in the event of an emergency, all efforts to contact me and/or my emergency contact numbers will be made by the Motivate Me staff. In order to meet legal requirements, I hereby authorize representatives of TACAC and Motivate Me to give consent for any and all necessary emergency medical/dental care for my child/ward, named above, while said individual is participating in the conference.

*Required:

I understand and agree to the terms.

Student Code of Conduct

Each student who chooses to participate in Motivate Me must adhere to the Code of Conduct. In an effort to ensure that each student and staff member can take full advantage of the experience, all participants (students and chaperones) will:

o Wear name tags to all workshops

o Attend all workshops planned

o Remain on campus at all times unless otherwise instructed by Motivate Me staff

o Use positive and proper language and refrain from using foul and offensive language

o Conduct oneself in a respectful manner and refrain from engaging in disruptive behavior

o Respect the college campus and refrain from damaging campus property

o Respect each staff member, chaperone and student

o Refrain from using alcohol, tobacco and other drugs

o Wear appropriate conference attire

o Restrict use of cell phone to designated free time

o Refrain from wearing hats and sunglasses indoors, and during sessions

o Be willing to learn new things, stay open-minded and HAVE FUN

Page 5 of 6

I hereby agree that my child/ward will adhere to the policies set forth by Motivate Me staff. I acknowledge that if these rules are not followed, I may be contacted. In the unlikely event of damage to college property by a student, the parent/guardian will incur the expense.

*Required:

I understand and agree to the terms.

Signature Please type or sign your full name below to agree to all of the above terms policies, releases, and certify the information provided above is true and correct.

Page 6 of 6