My minor child, _________________________, (“the Minor”) has been accepted as a tutee in the UNCW Ed Lab Tutoring Program
(hereinafter “Program”). It is coordinated by University of North Carolina Wilmington (hereinafter “UNCW”) The Minor has my consent to attend. I understand the nature and requirements of the Program. With that understanding, it is my judgment that the
Minor is qualified and able to participate in the Program. I acknowledge that the Minor’s participation in the Program is voluntary.
Due to the age of the Minor, UNCW requires that this Agreement be executed by me in consideration of the Minor’s being permitted to enroll in the Program. I agree to and acknowledge the following:
(1) I am the Minor’s parent or legal guardian.
(2) I agree to drop the Minor off just prior to the start of the Program period and will pick up the Minor immediately following the end of the Program period. I understand that neither the faculty member, teaching assistant, any other student nor any administrator or staff member of UNCW shall be responsible for supervision of the Minor both before and after the Program times.
(3) I agree that the Minor will abide by all of rules and regulations and, if found in violation, may be removed from the Program either temporarily or permanently. I understand that UNCW may withdraw the Minor’s participation if these programs are disrupted or altered in any way by the Minor’s behavior. I further agree that as a parent or guardian of the Minor, I take full responsibility for the behavior and conduct of the Minor and any consequences resulting from his or her actions.
(4) I agree that the Minor may be photographed, audio or videotaped by UNCW. I agree that photographic image(s) and information that correspond with the photographic image(s) may be disseminated for any public usage by UNCW.
(5) As parent of the Minor, I understand that there are safety risks associated with the Minor’s participation in programs and activities designed for children. I acknowledge and agree that I have had the opportunity to ask questions of UNCW officials concerning these matters, and all questions have been answered to our satisfaction.
(6) On behalf of ourselves, our heirs, executors, and administrators, I waive and release forever any and all rights for claims and damages I may have against UNCW (both individually and jointly), their trustees, officers, employees, and agents in any manner due to any personal injury or property loss sustained as the result of the Minor’s participation in the Program. I hereby indemnify and hold harmless from and against any and all claims, demands, judgments, losses and expenses, including, but not limited to, attorneys’ fees for personal injury or death to the Minor or damage to the Minor’s property during the Program period arising out of or resulting from the negligent or wrongful acts or omissions of UNCW, and their employees and agents with the exception of gross or willful misconduct.
(7) I agree that should there be disagreements or problems with the implementation of this agreement, the laws of North Carolina will govern any resolution. I further agree that should litigation or grievances result, the forum for any lawsuit, hearing or adjudication shall be in North Carolina.
(8) As parent of the Minor, we agree that I will promptly communicate any problems or issues associated with the Minor’s participation in the Program with UNCW officials. I further agree that I will promptly report and disclose to UNCW officials all pertinent information concerning the Minor’s ability to participate successfully in the Program.
During the Program times, my emergency contact numbers are:
(cell) ___________________________, (home) ______________________________, (work) ____________________________
Address:_________________________________________________________________________________________________
street city state zip
Medications or other health considerations (including allergies):
________________________________________________________________________________________________________
____________________________________________
Parent/Guardian Signature
________________________
Date
____________________________________________
Print Name
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UNCW Campus Release Tutee Ed Lab June 2010