MEDICAL WAIVER & MEDIA RELEASE FORM This is a waiver and media release of liability and indemnification for Indiana Black
Expo, Inc. and of its sponsors, partners, venues, and their owners. Being a parent or legal guardian (both referred to herein of the registrant and not being an employee of the Parties nor any individual Party, desire for my child to participate in all activities included as a part of the IBE Youth Summit & Summer Celebration and specifically, by his/her participation in physical endeavors ("Activities") offered or hosted by IBE. I fully understand the risks involved and that it is possible for my child to sustain serious injury, permanent disability, and/or death during the course of said Activities. However, in partial consideration of the opportunity for my child to participate in the Activities, I individually and for my Child covenant not to sue and forever discharge the Parties, their respective venues, vendors, sponsors, subcontractors, volunteer, agents, partners, officers, directors, employees, trainers, physicians, licensees, lenders, subsidiaries, representatives, shareholders, agents, insurers, successors, and assigns (hereinafter collectively known as "Releasees") from any and all liability to the undersigned, my Child, my Child's other Parent, personal representatives, assigns, heirs and next of kin for any and all loss and damage, and any claim or demands therefore on the account of any injury, illness or death suffered by my Child in connection with the Activities, whether caused by sole or concurrent negligence of Releasees or otherwise. I, individually and for my Child and my Child's other Parent, further do hereby indemnify and hold harmless said Releasees against any and all losses, and/or expenses (including but not limited to legal fees) that they may incur as a result of claims made as a result of my Child's participation in the Activities. I also hereby give my permission for IBE to collaborate with my child's school system, in securing copies of grades, attendance, discipline referral, suspension information, and school counselor's reports, to help IBE staff support my child's educational process. My child may also participate in prevention, intervention, and recreational programs which are focused on assisting youth with saying NO to drugs and making positive and healthy decisions. These programs will ask my child if he/she would like to participate in voluntary surveys. My child's name will NOT be used on surveys! I hereby give Indiana Black Expo, Inc., permission to use and authorize others (media outlets) to use all or any part of my (his/her) interview/photograph/video in IBE related media such as books, magazines, journals, pamphlets, electronic (Internet) and other written and video formats, regardless of the medium by which it is recorded. I warrant and represent that I have been authorized by my Child's other Parent to execute this release for my Child's other Parent.
IBE reserves the right to remove any participant from the conference who demonstrates and symptoms associated with COVID-19.
I will make sure my child has any prescription medication that has been prescribed to him/her with them for the YES activities.