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Virtual Teen Science Cafe: Self-Organization in Biology | MONDAY, DECEMBER 14, 2020: Liability Waiver, Indemnification Agreement & Photo Release

This agreement (the “Agreement”) governing participation in the VIRTUAL TEEN SCIENCE CAFE: SELF-ORGANIZATION in BIOLOGY scheduled on DECEMBER 14, 2020, 6PM, CST, is made by the undersigned as the legal parent/guardian (“I” or “me”) for the minor child ("minor," "minor child," or "student") as defined below.  In consideration of the services and participation in VIRTUAL TEEN SCIENCE CAFE: SELF-ORGANIZATION in BIOLOGY, I understand and agree as follows:

As parent or guardian of the below named student/minor child, I hereby grant permission for my student/minor child to participate in the VIRTUAL TEEN SCIENCE CAFE: SELF-ORGANIZATION in BIOLOGY

  1. I recognize that my student/minor child will be participating in video/audio conferencing technology such as Zoom for the VIRTUAL TEEN SCIENCE CAFE EVENT: SELF-ORGANIZATION in BIOLOGY. I recognize for this event, during the video/audio conference, my student/minor child may be visible/audible to other participants (members of the STEM Teens Leadership Council, The Academy of Science of St. Louis Staff and its designees, and/or teen participents/members who attend Teen Science Cafes) in the conference or webinar sessions. I recognize that it is also possible that others in the participant's households may see or hear the participants. I recognize that if I/or my minor child do not wish to share my/their camera and/or my/their audio capabilities, I/they may turn them off and attend the meeting/conference/event as a viewer.
  2. I hereby grant The Academy of Science of St. Louis the right to use on their websites, informational materials, and in advertising and promotional materials, excluding any personal identifying information about me, or my minor child, unless specific permission for use of said personal identifying information is obtained from myself and said minor child by the Academy Parties, any photograph/screenshot/video recording taken of said minor child during their participation in VIRTUAL TEEN SCIENCE CAFE EVENT: SELF-ORGANIZATION in BIOLOGY. I agree not to revoke this permission.
  3. To the fullest extent allowed by law, I, as legal parent or guardian of the participating minor child, and on behalf of myself and said participating minor child, hereby (i) waive and discharge any and all claims of any kind against the Academy Parties arising out of VIRTUAL TEEN SCIENCE CAFE EVENT: SELF-ORGANIZATION in BIOLOGY (ii) release the Academy Parties from any and all liability resulting from injuries and damages to me or my minor child arising out of or because of my or my minor child's participation in VIRTUAL TEEN SCIENCE CAFE EVENT: SELF-ORGANIZATION in BIOLOGY even if caused by negligence of one or more of the Academy Parties (iii) and defend, indemnify and hold harmless the Academy Parties from any claims, damages, injuries, or losses which are in any way connected with my or my minor child's participation in VIRTUAL TEEN SCIENCE CAFE EVENT: SELF-ORGANIZATION in BIOLOGY, even if such claims allege negligent acts or omissions of one or more of the Academy Parties. The "Academy Parties" means The Academy of Science of St. Louis and all of their affiliates, agents, directors, trustees, officers, consultants, employees, and persons or entities acting in any capacity on their behalf in connection with the VIRTUAL TEEN SCIENCE CAFE EVENT: SELF-ORGANIZATION in BIOLOGY.
  4. If the Academy Parties incur attorneys’ fees and costs in the course of enforcing this Agreement, I will indemnify The Academy of Science of St. Louis and hold them harmless of all such fees and costs.
  5. I agree that parties are collectively The Academy of Science of St. Louis and participating individuals, organizations and supporters by virtue of contributions of services, funds or expertise, including without limitation The Academy of Science of St. Louis and all of their affiliates, agents, directors, officers, consultants, employees, students and persons or entities acting in any capacity on their behalf in connection with The Academy of Science of St. Louis.
Participant's
Minor
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First Student Participant Name

First Name*

Last Name*
First Student Participant Age Acknowledgment*
First Student Participant Date of Birth*
I certify that I am 18 years of age or older
First Student Participant Information
Gender (This question is asked for purposes of understanding our population better and fulfilling grant reporting requirements. Thank you!)*

Current Grade *

Student Email *

Parent/Guardian Home Street Address

City

State

Zip Code

Parent/Guardian Primary Phone Number (xxx.xxx.xxxx) Please enter area code + phone number as 314-555-5555. *
Parent/Guardian Primary Phone is:*
Cell
Home
Work

Parent/Guardian Secondary Phone Number (xxx.xxx.xxxx) Enter N/A if not applicable, or if same as cell number. Please enter area code + phone number as 314-555-5555. *
Parent/Guardian Secondary Phone is:*
Cell
Home
Work
First Student Participant Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Gender (This question is asked for purposes of understanding our population better and fulfilling grant reporting requirements. Thank you!)*

Current Grade *

Student Email *

Parent/Guardian Home Street Address

City

State

Zip Code

Parent/Guardian Primary Phone Number (xxx.xxx.xxxx) Please enter area code + phone number as 314-555-5555. *
Parent/Guardian Primary Phone is:*
Cell
Home
Work

Parent/Guardian Secondary Phone Number (xxx.xxx.xxxx) Enter N/A if not applicable, or if same as cell number. Please enter area code + phone number as 314-555-5555. *
Parent/Guardian Secondary Phone is:*
Cell
Home
Work
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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