As the legal Parent or Guardian, I hereby consent to and authorize the Minor to act as a participant and volunteer in programs led by Achieve Miami, Inc. (“Achieve Miami”) as of the date I indicate my approval of this consent form. I agree and understand that the Minor must comply with the rules and regulations established from time to time by Achieve Miami and that failure to do so may result in the Minor’s immediate removal as a participant.
I am aware of the nature of the activities to be performed by the Minor as a participant. These activities may include but are not limited to the duties listed: participating in Achieve Saturdays, music lessons with Achieve Miami staff, and other activities as part of these programs. On behalf of myself, the Minor, and our respective heirs and personal representatives, I agree to indemnify and hold Achieve Miami and all of its officers, employees, representatives, and volunteers free and harmless from and against all claims, damages, losses, and expenses, including attorney fees, that the Minor may sustain while participating. I hereby release and discharge Achieve Miami and all of its officers, employees, representatives, and volunteers from any and all claims, demands, and causes of action of any nature or cause for any such injury or damage incurred or suffered by the Minor.
I have carefully read this Form, which is an agreement, waiver, and release, and I fully understand its contents. I am aware that this is a release of liability and a contract between Achieve Miami and myself, and I sign it of my own free will.
PARENT/GUARDIAN CONSENT FORM: ACHIEVE MIAMI PROGRAMMING
PHOTOGRAPHY, VIDEOTAPING, AND OTHER IMAGING FOR EDUCATION, MARKETING, MEDIA, AND/OR OTHER PURPOSES:
I, as a legal parent/guardian of a student participating in Achieve Miami’s programs, give my express consent to have photographs, statements, published articles, videotaped images, other images, or audio recordings made of my child who is a minor:
- Achieve Miami publications, fundraising, publicity, marketing, promotion, web content, or advertising;
- Research and/or education programs; and,
- Publications and newspapers, printed media, radio, television, web content, social media, and/or all other types of electronic communication media.
I consent to the taking and use of photographs, films, audio, and/or video, or publishing of the above-referenced information of my child, including placement of the same in a central repository for Achieve Miami’s use, i.e. reuse unless otherwise indicated. I understand that my child may be identified in any use of the above-referenced materials. I acknowledge that neither I nor my child will be compensated in any way for the taking or use of photographs, films, audio, and/or video, or the publishing of the attached article or information. I understand that Achieve Miami may receive money or other compensation (directly or indirectly) from someone else because of the use of my child’s information as described above. I understand and agree that this Media Consent & Release is valid unless I cancel it in writing (as described in the next sentence) for as long as Achieve Miami (or any organization that succeeds it) stays in business.
I understand that I may cancel this Media Consent & Release at any time (as long as Achieve Miami has not taken action in reliance on this Media Consent & Release) by mailing a letter via Certified U.S. Mail to Achieve Miami at 220 Miracle Mile, Suite 236, Miami, FL 33134. I understand that once my child’s information is used or disclosed, it may no longer be protected by applicable local, state, or federal laws, if any, and that it may be redisclosed by any recipients. I understand that neither Achieve Miami nor any of its representatives can make me sign this Media Consent & Release as a condition to my child participating with Achieve Miami as a volunteer, client, employee, independent contractor, team member, or in any other capacity.
Obligations of Activity Participants Waiver, Release & Hold Harmless COVID-19 and Voluntary Third-Party
Extracurricular Activities School Year 2022-23
Extra-Curricular Activity: Achieve Summer
- I desire to participate or allow my child(ren) (“Activity Participant”) to participate in one or more voluntary extracurricular activities being held on the campus(es) of the School Board of Miami-Dade County, Florida (“School Board”). I acknowledge that the novel coronavirus known as COVID-19 has been declared as a worldwide pandemic and is believed to be contagious and spread by person-to person contact, including in Miami-Dade County. I further acknowledge that federal, state, and local agencies recommend social distancing and other measures to prevent the spread of COVID-19. The School Board will have third-party organizations (“Organizations”) conducting certain extracurricular activities, including summer camps, on its campus(es) beginning in the Summer of 2022 and continuing into the 2022-23 school year.
- I understand that if I or my child(ren) choose to participate in these Organizations’ activities (hereinafter “Activity”), the Activity will be controlled, organized, contracted, staffed and insured independent of the School Board, and will be conducted with the safety protocols these Organizations deem appropriate under the circumstances at the time, which may be subject to change.
- I understand that the School Board will not be responsible for implementing, supervising, or informing the Activity Participant(s) of this Organization’s safety protocols, and that it is solely my responsibility, as well as the Activity Participant’s, to adhere to all state, federal, and local safety protocols, as well as those the Organization provides. In an effort to ensure the safety and wellness of our school community, I understand the importance of Activity Participants, including my child(ren), being healthy and safe when they participate in the Activity. By signing below, I agree that I will: • Perform daily temperature checks on my child(ren) to screen for fever before arrival to the Activity. Fever is defined as a temperature over 100.4 F or 38.0 C. If my child(ren) has a fever,
- I will not permit my child(ren) to participate in the Activity until he/she has been without a fever for at least 72 hours. • Make a visual inspection of my child(ren) for signs of illness which could include: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, flushed cheeks, rapid breathing or difficulty breathing (without recent physical activity), fatigue, or extreme fussiness. If my child(ren) has exhibited any of these signs or symptoms,
- I will not permit my child(ren) to participate in the Activity until he/she has been without signs or symptoms for at least 72 hours. FM-6103 Rev. (0-8-20) • Confirm that my child(ren), before and while participating in the Activity, has not tested positive for COVID-19 in the past 14 days, is not waiting for test results based on a diagnosed or suspected case of COVID-19, and has not within 14 days returned from an area subject to CDC Level 3 Travel Health Notice. • Confirm that my child(ren), before and while participating in the Activity, has not been in contact with someone who has either tested positive for COVID-19 in the past 14 days, is waiting for test results based on a diagnosed or suspected case of COVID-19, or has returned from a highly impacted area subject to a CDC Level 3 Travel Health Notice.
- If my child(ren) has been in contact with such a person, including from the same household, I will not permit my child(ren) to participate in the Activity until 14 days have elapsed since the time of contact.
- • Promptly pick up my child(ren), or arrange for pickup, if signs or symptoms of illness are present. I understand that children are to remain home until illness-free for at least 72 hours without the use of medicine.
I acknowledge and affirm all of the statements above. I also understand that I or my child(ren) may unavoidably be exposed to or infected by COVID-19 as a result of participation in the Activity and that such exposure or infection may result in personal injury, illness, sickness, and/or death. I understand that the risk of exposure or infection may result from the actions, omissions, or negligence of myself, my child(ren), these Organizations, School Board staff, volunteers, or agents, other Activity participants, or others not listed, and I acknowledge that all such risks are known to me. In consideration of my and/or my child(ren) being able to participate in the Activity, I, on behalf of myself and my child(ren), as well as anyone entitled to act on my behalf, hereby knowingly and voluntarily forever waive, release, and hold the School Board and its employees and agents harmless from any and all claims, suits, liability, actions, judgments, attorneys’ fees, costs, and any expenses of any kind resulting from injuries or damages, grounded in tort or otherwise, that I and/or my child(ren), or my or our representatives, sustain during or related to my child(ren)’s participation or involvement in the Activity.
If this Waiver, Release, and Hold Harmless or any portion thereof is determined to be invalid or unenforceable for any reason, the remaining provisions of this Waiver, Release, and Hold Harmless, as well as any other agreement(s) concerning my or my child(ren)’s participation in this Activity, shall be unaffected and remain in full force and effect.
Please accept the terms & conditions to submit this form.