Emory National Debate Institute

Release of Liability, Covenant Not to Sue and Assumption of Risk

Student Name Student Name First Last
Name of Parent/Legal Guardian Completing Form Name of Parent/Legal Guardian Completing Form First Last
Relationship to Student
Parent/Legal Guardian Phone Parent/Legal Guardian Phone - ### - ### ####
Parent/Legal Guardian Email Address
Parent/Legal Guardian Address Parent/Legal Guardian Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Student Medications (if any)
Student Allergies (if any)
Student medical condition(s) of which we should be aware
Student's Medical Provider
Medical Provider Phone Medical Provider Phone - ### - ### ####
Student Date of Birth Student Date of Birth / MM / DD YYYY
Insurance Company
Medical Insurance Policy/Group Number
Emergency Contact Name and Relationship to Student
Emergency Contact Phone Emergency Contact Phone - ### - ### ####
Alternate Emergency Contact Name and Relationship to Student
Alternate Emergency Contact Phone Alternate Emergency Contact Phone - ### - ### ####
As parent or legal guardian of aforementioned student participant, (hereinafter "Student"), I hereby grant the permission necessary to allow Student to participate in the Emory National Debate Institute ("the Program") to be conducted at Emory University ("Emory") June 2, 2024 – June 15, 2024. I understand that Emory does not guarantee the suitability of the Program for Student’s participation. I understand that there are inherent risks involved in participating in the Program, and I realize that participation in the Program is my and the Student’s choice. I am aware that, during the Program, certain risks and dangers may occur, including, but not limited to, the hazards of traveling by automobile, bus or other conveyance; accident or illness; the forces of nature; all manner of foreseen and unforeseen bodily and personal injuries, including death; damage to property; and the consequences resulting therefrom.

I understand that it is my and the Student’s responsibility to know what personal equipment is required (such as footwear and clothing) and provide the proper personal equipment for Student’s participation in the Program, and to ensure that it is in good and suitable condition. I agree to ask questions to make sure that the Student knows how to safely participate in the Program activities. IN CONSIDERATION OF STUDENT BEING PERMITTED TO ATTEND AND PARTICIPATE IN THE PROGRAM, I ACKNOWLEDGE AND VOLUNTARILY ASSUME ALL RISKS ASSOCIATED WITH THE PROGRAM.

I, on my own behalf and on behalf of the Student, our heirs, representatives, executors, administrators and assigns, for the sole consideration of Student being allowed to attend and participate in the Program, do hereby release, relieve, covenant not to sue and forever discharge, defend, indemnify and hold harmless, Emory University, its trustees, officers, agents, employees, students, and volunteers (hereinafter collectively "Emory") of any and from all claims, demands, rights, liabilities, losses, expenses, and causes of action (with the exception of gross negligence or willful misconduct) of whatever kind or nature including, but not limited to, negligence, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property, and the consequences thereof, including death, resulting from any participation in or in any way connected with or arising out of the Program, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death) that the Student may incur or sustain during the Program, all activities associated with the Program and while traveling to and from the site for the Program whether or not the Program actually occurs. I, ON MY OWN BEHALF AND ON BEHALF OF THE STUDENT, HEREBY WARRANT THAT I HAVE READ THIS RELEASE OF LIABILITY IN ITS ENTIRETY AND FULLY UNDERSTAND ITS CONTENTS. I, ON MY OWN BEHALF AND ON BEHALF OF THE STUDENT, AM AWARE THAT THIS RELEASE OF LIABILITY RELEASES EMORY FROM LIABILITY AND CONTAINS AN ACKNOWLEDGEMENT OF MY VOLUNTARY AND KNOWING ASSUMPTION OF THE RISK OF INJURY OR ILLNESS.

Media Release. For good and valuable consideration herein acknowledged as received, I on my own behalf and on behalf of the Student, hereby grant to Emory, and those acting with Emory’s authority and permission, the irrevocable and unrestricted right and permission to create, use, re-use, publish and re-publish video recordings, audio recordings, photographs, or other media that contain or capture the Student’s likeness or voice or in which the Student’s likeness or voice may be included (the “Recordings”) in connection with any publication or materials relating to or serving the mission and goals of Emory, including advertisements, brochures, or other promotional materials. The Recordings may be used with or without the Student’s name, and in any and all media now or hereafter known. I acknowledge and agree that Emory owns all right, title, and interest in and to the Recordings, including all copyrights therein and the full and unrestricted right to edit and modify the Recordings, and I hereby assign and agree to assign any such interest that I may own or control to Emory. I also consent to the use of any printed matter in conjunction with the Recordings. I hereby waive any right I may have to inspect or approve the Recordings or any finished product or products incorporating the Recordings and any written or other print material that may be used in connection therewith, including print material containing the Student’s name. I acknowledge that nothing in this Agreement obligates Emory or any third party to make any use of the Recordings.

Medical Release. I, on my own behalf and on behalf of the Student, acknowledge that the Student is in good health, physically fit and mentally capable of participating in Program activities and is covered by accident and health insurance, and I hereby give full approval for Student’s participation in the Program. In the event of any illness or injury, I authorize Emory to obtain necessary medical treatment of the Student and hereby, on my own behalf and on behalf of the Student, release and hold harmless Emory in the exercises of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related bills that may be incurred on behalf of the Student for any illness or injury that the Student may sustain during the Program and while traveling to and from the site for the Program.

Program Rules/Expectations of Conduct. I further acknowledge and understand that Emory has established rules and regulations pertaining to conduct, behavior and activities of all participants by which the Student and I agree to abide during the Program, and that the Student and I will be responsible for his/her/my failure to abide by those rules and regulations. The Student and I understand that violation of the rules below can result in dismissal from the Program.
1. Attendance at all Emory National Debate Institute (ENDI) classes and functions is required and verified by regular roll call. Tardiness and other infractions of rules will result in a punitive measure (e.g., residence hall cleaning, essay, etc.) to encourage maximum learning from the program. Absence from the functions of the ENDI must be in writing from the parents or guardians.
2. Residential students are not permitted to operate motor vehicles during the ENDI. Commuting students are not permitted to transport any other ENDI students without written mutual parental consent and the permission of the ENDI director.
3. Residential students are required to be inside their assigned residence halls (entrance doors remain locked) by 10:00 p.m. for formal check-in by faculty and staff. All students must be in their residence hall rooms by 11:00 p.m. unless granted permission by the residence directors.
4. Students are not permitted to leave the Emory campus unless for an event sponsored by the Emory National Debate Institute or unless they have received written parental permission. Failure to abide by this regulation results in expulsion from the ENDI.
5. Alcoholic beverages and narcotics or other controlled substances, weapons, or threatening behaviors are not permitted; any student found in possession thereof or engaging in thereof will be required to leave the ENDI at the cost of the student or guardians of the student.
6. Discriminatory harassment or behavior of any kind, whether it is sexual harassment or harassment on the basis of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, veteran status, or any factor that is a prohibited consideration under applicable law is not permitted, whether in person or through email, social media, electronic communications or other means. If this policy is violated, the offending student may be required to leave the ENDI at the cost of the student or guardians of the student.

These regulations are not all-inclusive. Additional rules regarding individual conduct may be given (e.g., residence hall rules, library rules, etc.). Violation of any of these rules or the additional rules provided to the students may result in subsequent termination from the program.

Insurance and Medical Information. I represent that any medication to which the Student is allergic or medications that Student is currently taking are listed below. I agree that the Student shall bring medications which the Student is currently taking with him/her to the Program and that he/she shall consume the prescribed dosage for such medications. Emory will not administer or supply any type of medication at the Program.

BY SIGNING BELOW, I, ON MY OWN BEHALF AND ON BEHALF OF THE STUDENT HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ AND UNDERSTOOD THE ABOVE BEFORE SIGNING AND AGREE TO COMPLY WITH THE ABOVE PROVISIONS. I INTEND THIS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT, IF ANY PORTION OF THE RELEASE IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. I expressly agree that this Release shall be governed by and interpreted in accordance with the laws of the State of Georgia without regard to conflict of law principles.

Draw or Type

Clear

Full Name
Today's Date Today's Date / MM / DD YYYY
I, identified above as Student, acknowledge that I have read and understand the Program Rules and agree to abide them.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.