If an emergency or a crisis arises, university or program staff may get in touch with a parent or guardian.

I, {name-2-first-name} {name-2-last-name}, am the Parent/Legal Guardian of {name-1-first-name} {name-1-last-name} and I ask that he/she be permitted to participate in the above named program. I understand and acknowledge that scheduled activities of the program include inherent risks listed above. I understand that activities of the Program may include interactions with adult staff from Illinois Wesleyan University, Illinois State University, Northern Illinois University, Southern Illinois University Edwardsville, Celebrating High School Innovators, community members, and other youths from the community. I also understand that my child/guard must adhere to all rules and regulations of Illinois Wesleyan University during participation in the program. To the best of my knowledge my child/guard does not have any medical condition or physical limitation that would put him/her at risk for injury as a result of his/her participation in the program.

In consideration of my child/guard's participation in the program, I understand and acknowledge that we are assuming all risks of injury or damage to personal property which may result from participation in the program and his/her use of Illinois Wesleyan University facilities and I hereby waive, release and hold harmless Illinois Wesleyan University, and its affiliates and subsidiaries as well as its trustees, officers, directors, representations, employees and agencies, successors and assigns of and from any and all actions, causes of action, suits, claims, damages, and expenses whatsoever for any injury, loss, damage, accident,
inconvenience or expense, relating to or arising from his/her voluntary participation in the program, unless otherwise provided for by law.

EMERGENCY TREATMENT:
In case of accident, illness or other emergency, I request that the Program/Activity Event Organizer contact me. If neither I or another emergency contact cannot be reached after conscientious effort, I give permission for the Program/Activity Event organizer or staff member to call paramedics or any licensed physician or dentist. In case of a life-threatening emergency, I give permission for Program/Activity Event Organizer or staff member to call paramedics immediately and then contact me as soon as possible thereafter.

PHOTO RELEASE:
I hereby grant Illinois Wesleyan University permission to use my likeness and audio recording in a video or other digital media for use by the University for any advertising, marketing or promotional purposes, without payment or other consideration.

I understand and agree that all videos and digital media will become the property of Illinois Wesleyan University.

I hereby irrevocably authorize Illinois Wesleyan University to edit, alter, copy, exhibit, publish, or distribute these videos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product in which I am featured. Additionally, I waive any right to royalties or other compensation arising or related to the use of the video.

I hereby hold harmless, release, and forever discharge Illinois Wesleyan University from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT: