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Washington University in St. Louis Society of Women Engineers

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Note: Registration for the 2013 Women in Engineering Day is now closed.

 

See our page on Women in Engineering Day for more information.

 

Fill out the consent form below to participate and mail with your check to:

 

Office of Student Activities - Attn: Society of Women Engineers

Washington University

Campus Box 1128

One Brookings Drive

St. Louis, MO 63130

 

PARENT/GUARDIAN APPROVAL FOR PARTICIPATION

 

I hereby certify and agree that

 

____________________________________________ (Please print: First, Middle, Last Name of Child) (hereinafter, “My Child”) has my approval to participate in the Society of Women Engineers’ Women in Engineering Day (hereinafter “the Activity”) to be held on Saturday, February 23rd, 2013 (with optional overnight stay on Friday, February 22nd, 2013), at Washington University in St. Louis.

 

I know the nature of the Activity and My Child’s experience and capabilities and consider My Child to be qualified to participate in the Activity. However, I acknowledge that there are certain risks of physical injury or illness associated with the Activity.

 

In return for My Child’s participation in the Activity: I fully and forever RELEASE, WAIVE, DISCHARGE, ACQUIT, INDEMNIFY, HOLD HARMLESS and COVENANT NOT TO SUE, Washington University in St. Louis, including its governing board, officers, employees, students, agents and volunteers (hereinafter collectively referred to as “Releasees”) from any and all liabilities, claims, or injuries, including death, that may be sustained while participating in this activity, including but not limited to travel to, from, and for the activity, or while on premises owned or controlled by Releasees. I understand this release does not apply to injuries caused by intentional or grossly negligent conduct on the part of the Releasees. I further agree to indemnify and hold harmless Releasees for any loss, liability, claim or injury caused by me (my child) while participating in this activity including traveling to, from, and for the activity, or while on premises owned or controlled by Releasees.

 

I recognize that the Releasees do not assume responsibility for or liability for - including costs and attorney’s fees - any accident or injury or damage resulting from any aspect of participation in the Activity. The Releasees are not liable for any special, incidental or consequential damages arising out of or in connection with any aspect of participation in the Activity.

 

I also give permission for My Child to receive any emergency medical treatment by a healthcare professional, including emergency medical transportation, which may be required for injuries sustained by My Child. However, I agree that the Releasees (including, but not limited to, each of the Releasees’ regents, boards, agents, employees, officers or representatives) are not responsible for any medical bill incurred as a result of any personal illness or injury to My Child, even if a Releasee has signed hospital documentation promising to pay for the treatment. That medical bill is my responsibility.

 

I understand that by signing this document, I give up substantial rights that I or My Child would have otherwise to receiver damages for any loss occasioned by Releasees’ fault, and I sign it voluntarily and without inducement.

THIS IS A WAIVER OF LEGAL RIGHTS.

READ AND UNDERSTAND BEFORE SIGNING.

 

________________________________________

Signature of parent/guardian

 

________________________________________

Daytime Phone (parent/guardian)

 

________________________________________

Date

 

 

Insurance Company: _______________________________________________________

 

Policy Number: ___________________________________________________________

 

Name of Primary Policy Holder: ______________________________________________

 

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