Constitutional Rights Foundation S

San DiegoCountyHighSchoolMockTrialProgramCompetition2016-2017StudentPermissionSlip

PLEASEREADBOTHSIDES OFTHISPERMISSIONSLIPINITIALANDSIGNWHEREAPPLICABLE

I (as the parent/guardian) request and give my permission to have (Student’s name)from (highschool name) participateinthe2016-17SanDiegoCountyHighSchoolMockTrialProgramCompetition.We(StudentandI)havereviewedandunderstandtherules,guidelinesandexpectationsoftheProgramandCompetition.Thispermissiongrantedisvalidfromthelatterofmystudent’sparticipationdateorSeptember21, 2016throughandincludingMarch20, 2017.

Health:MedicalorOtherSpecialNeeds.Indicatebelowasapplicable:

□Mychild hasNOspecial needsthe staffshouldbe madeawareof.

□Mychild has special needsandinstructionsareattached.Pleaseadviseofanyallergiesetc.

□Other:

ReleaseandCovenantNottoSue/AuthorizationforMedicalCare:

Initials

Inconsiderationfortheparticipationoftheabove-listedstudentintheSanDiegoCountyHighSchoolMockTrialProgramCompetition,Iagreetoindemnify,defendandholdharmlesstheSanDiegoCountyBarAssociation(SDCBA),SuperiorCourtofCalifornia,CountyofSanDiego,UnitedStatesDistrictCourt,SouthernDistrictofCalifornia,ConstitutionalRightsFoundation(CRF)and/oranyotherprogramorganizer(s)and/orsponsor(s)foranyandallclaims,damages,costsandexpenses(includingattorney’sfees/costs)resultingfromlawsuitsand/orotherproceedingsbyanythirdpartiesarisingoutofanyacts,omissions orconductofmyabove-listedchildwhiles/heisparticipatingin theSanDiegoCountyMockTrialProgram Competition.

Iauthorize and agreetohave mychildreceive anyemergencymedical services deemed necessarybythose inchargeoftheProgramandCompetition.Iunderstandandagreethatanyresultingmedical/transportationexpenseswillbemyresponsibilityofthe minorstudent astheirparent/guardian.

Initials

TheundersignedacknowledgesthattheProgramandCompetitionaddressedbythisreleaseiscompletelyVOLUNTARYonbehalfoftheparticipantstudentsandisalsocompletelystaffedvoluntarilybythesponsoragenciesandtheir employees.

EmergencyContactInformation:

NameContact Phone

IfI cannot bereachedincase ofemergency, pleasenotify:

NameCellPhoneWork PhoneHomePhone

Medical InsuranceCompanyPolicyNumberGroupPlan

[PhysicianContact]

AuthorizationandRelease FormforPhoto/Video/Website Usage

MinorChild/StudentParticipant

I,theparent/guardianof,aminorchild/studentparticipantundereighteen(18)yearsofage,havenoobjectionto,andallowthe useof,theabove-namedminorchild’s photographic and/or video imagesbytheSanDiegoCountyBarAssociation(SDCBA),SuperiorCourtofCalifornia,Countyof SanDiego,andthe UnitedStates DistrictCourt,SouthernDistrictofCalifornia.Iherebygivepermissiontorepresentativesoftheabove-namedorganizationstotakephotographsand/orvideoimagesoftheabove-named minorchild/studentparticipant(whichIamduly authorizedtogrant)duringtheProgramandCompetition,touseorreusetheimagessotakeninprintorpublicationinanymediumorform,includingbutnotlimitedto,electronicformontheabove-listedorganizations’websitesinordertopromotetheSanDiegoCountyHighSchoolMockTrialProgramCompetition,foranylengthoftime.BygrantingthisauthorizationIagreethatIshallnotreceive,norbeentitledtoreceiveanyfeesorcompensationwhatsoeverfromtheseorganizations,andthatallrights,title,andinteresttotheimagesanduseofthembelongtotheorganizationslistedabove.Ialsowaivetherighttoinspectorapprovethefinalproduct,includingwrittenorelectroniccopyinwhichmylikenessappears.Ifurtherreleaseandagreetoindemnifyandholdharmlesstheabove-namedorganizations,includingtheirofficers,agents,employees,andvolunteers,fromanyandallliabilityandresponsibilityforanyclaimorcauseofactiononaccountofanyinjury,damage,expense,orotherlossinanyway associated,directly orindirectly,withtheappearanceofabove-namedminorintheseimagesand/ortheiruse,prosecutedorbroughtforthontheirbehalformybehalfinvolvingtheminorchild/studentparticipant’simageand/orlikeness.Ihavecarefullyreadthisauthorizationandrelease,andfullyunderstanditscontents.IcertifythatIam18yearsofageorolder,amauthorizedtoexecutethisauthorizationandreleaseonmyownbehalfandonbehalfoftheabove-namedminorchild/studentparticipant,and/orfamily,andtheinformationprovidedbymeistrue,accurateandcompleteonthisAuthorizationandPermissionSlip.

Parent/GuardianName:(pleaseprint)

Parent/GuardianSignature:

AddressCellPhoneWorkPhoneHomePhone

AdultStudentParticipants&/OrParents/Guardians

I,,beingeighteen(18)yearsofageorover,havenoobjectionto,andallowtheuseof,myphotograph/video bythe SanDiego CountyBarAssociation(SDCBA),SuperiorCourtof California,County of San Diego,and theUnitedStatesDistrictCourt,SouthernDistrictofCalifornia.Iherebygivepermissiontorepresentativesoftheabove-namedorganizationstotakephotographicand/orvideoimagesofmeduringtheProgram andCompetition,touseorreusetheimagessotakeninprintorpublicationinany mediumorform,includingbutnotlimitedto,electronicformontheabove-listedorganizations’websites,foranylengthoftimeinordertopromotetheSanDiegoCountyHighSchoolMockTrialProgramCompetition. BygrantingthisauthorizationIagreethatIshallnotreceive,norbeentitledtoreceive,anyfeeorcompensationwhatsoeverfromtheseorganizations,and thatall rights, title, andinteresttothe images and useofthembelong totheorganizationslisted above.I alsowaivetherighttoinspectorapprovethefinalproduct,includingwrittenorelectroniccopyinwhichmyphotographicorvideolikenessappears.Ifurtherreleaseandagreetoindemnifyandholdharmlesstheabove-namedorganizations,includingtheirofficers,agents,employees,andvolunteers,fromanyandallliabilityandresponsibilityforanyclaimorcauseofactiononaccountofanyinjury,damage,expense,orotherlossinanywayassociated,directly orindirectly,withthe appearanceofmyselfintheseimagesand/ortheiruse,prosecutedorbroughtforthonmy behalfinvolvingmeormyimageand/orlikeness.Ihavecarefullyreadthisauthorization andrelease,andfullyunderstand itscontents.Icertifythat Iam18 years of age orolder,amauthorized toexecutethisauthorization and releaseonmyown behalf andonbehalfofmyselfand/orfamily,andtheinformationprovided bymeistrue,accurateandcomplete.

TobeinitialedbyAdultStudentInitials

PrintedName

Signature

Parent/GuardianattendingCompetitionInitials

PrintedName

Signature_