Barkley Forum for High Schools at Emory University
Barkley Forum for High Schools at Emory University
Release of Liability, Covenant Not to Sue and Assumption of Risk
Student Name
Student Name
*
First
Last
Student High School
*
Name of Parent/Legal Guardian Completing Form (if student is under the age of 18)
Name of Parent/Legal Guardian Completing Form (if student is under the age of 18)
First
Last
Relationship to Student
Parent/Legal Guardian Address (if student under age 18; otherwise, student address)
Parent/Legal Guardian Address (if student under age 18; otherwise, student address)
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
United States
United Kingdom
Canada
Australia
Netherlands
France
Germany
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Afghanistan
Albania
Algeria
Andorra
Antigua and Barbuda
Argentina
Armenia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
Gabon
Gambia
Georgia
Ghana
Gibraltar
Greece
Grenada
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
New Zealand
Nicaragua
Niger
Nigeria
Norway
North Korea
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Email Address of Person Completing Form
*
Phone Number of Person Completing Form
Phone Number of Person Completing Form
*
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I have agreed to participate in the Barkley Forum for High Schools speech and debate tournament through Emory University’s Barkley Forum for Debate, Deliberation, and Dialogue from January 26-28, 2024 (the “Program”). I acknowledge that I am covered by an accident and health insurance policy and am physically and mentally capable of participating in the Program. I understand that Releasees (as defined below) do not guarantee the competency or mental or physical condition of any person associated with the Program, the physical condition of any facility or equipment used in connection with the Program, or the suitability of the Program for my participation.
I understand that there are inherent risks involved in participating in the Program, and I realize that participation in the Program is my 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, van, ride sharing services like Uber, taxi, bus, rail or other conveyance; the hazards of large groups of people; 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 responsibility to know what personal equipment is required (such as footwear and clothing) and provide the proper personal equipment for my participation in the Program, and to ensure that it is in good and suitable condition. I agree to ask questions to make sure that I know how to safely participate in the Program.
I understand that, as part of my participation in the Program, I may be subjecting myself to exposure to individuals whose health history and exposure risk for COVID-
19 and other infectious diseases cannot be determined. Should I contract COVID-19 or have symptoms consistent with a COVID-19 diagnosis, I understand and agree that I will not participate in the Program in person in accordance with CDC standards. I am fully aware that a COVID-19 infection may cause serious illness or death.
I further understand that I am solely responsible for my health and safety, and I agree to abide by any decision of an Emory official relative to my ability to participate in the Program. I understand that I may be informed about certain safety protocols, including but not limited to, proper social distancing, hand sanitizing, and personal protective equipment, and I agree to follow these directives. I agree to ask questions to make sure that I know how to safely participate in the Program.
IN CONSIDERATION OF BEING PERMITTED TO ATTEND AND PARTICIPATE IN THE PROGRAM, I ACKNOWLEDGE AND VOLUNTARILY ASSUME ALL RISKS OF DAMAGES OR INJURY, INCLUDING DEATH, THAT I MAY SUSTAIN OR THAT MY PROPERTY MAY SUSTAIN WHILE I PARTICIPATE IN THE PROGRAM, ALONG WITH ANY TRAVEL TO OR FROM SUCH ACTIVITY OR THE PROVISION OF TRANSPORTATION TO OR FROM THE PROGRAM.
In addition, I, on my own behalf and on behalf of my heirs, representatives, executors, administrators and assigns, for the sole consideration of 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, and its trustees, directors, officers, agents, employees, students, members and volunteers, as applicable, (hereinafter collectively "Releasees") 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 arising out of or connected with the Program, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death) that I 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 events during the Program actually occurs. I HEREBY WARRANT THAT I HAVE READ THIS RELEASE OF LIABILITY, COVENANT NOT TO SUE AND ASSUMPTION OF RISK (“RELEASE” OR “RELEASE OF LIABILITY”) IN ITS ENTIRETY AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS RELEASE OF LIABILITY RELEASES RELEASEES 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 hereby grant to Releasees, and those acting with Releasees’ 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 my likeness or voice or in which my likeness or voice may be included (the “Recordings”) in connection with any publication or materials relating to or serving the mission and goals of Releasees’, including advertisements, brochures, or other promotional materials. The Recordings may be used with or without my name, and in any and all media now or hereafter known. I acknowledge and agree that Releasees’ own 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 Releasees. 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 my name. I acknowledge that nothing in this Agreement obligates Releasees or any third party to make any use of the Recordings.
BY SIGNING BELOW, I 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 and any action or proceeding brought to enforce rights under this Release shall be brought exclusively in any state or superior court of competent jurisdiction located in the County of Fulton, State of Georgia, USA or in federal court in the Northern District of Georgia.
Participant Signature
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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.
Date
Date
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MM
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DD
YYYY
Parent/Legal Guardian Signature (if participant is under 18 years of age); if participant signing above is over 18, write N/A in this signature field.
*
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.
Today's Date
Today's Date
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MM
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DD
YYYY