I am the Parent/Guardian of the above-named Participant who is under eighteen years of age and am fully competent to sign this Agreement.

I give permission for Participant to participate in the above-referenced Activity. I acknowledge that the nature of the Activity or Trip may expose Participant to hazards or risks that may result in Participant's illness, personal injury, or death, and I understand and appreciate the nature of such hazards and risks. I represent that the Participant is physically able, with or without accommodation, to participate in the above-referenced Activity or Trip, is able to use the equipment and/or supplies associated with the Activity or Trip, and has obtained all required immunizations.

In consideration of Participant being permitted to participate in the Activity or Trip, I hereby accept all risk to Participant's health and of his/her injury or death that may result from such participation and I hereby release the above-named institution, its governing board, officers, employees, and representatives from any and all liability to Participant, Participant's personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to Participant's property and for any and all illness or injury to Participant's person, including his/ her death, that may result from or occur during Participant's participation in the Activity or Trip, whether caused by negligence of the Institution, its governing board, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless the Institution and its governing board, officers, employees, and representatives from liability for the injury or death of any person(s) and damage to property that may result from Participant's negligent or intentional act or omission while participating in the described Activity or Trip.

I understand and agree that Institution does not have medical personnel available at the location of the Activity or on the campus. I understand and agree that Institution is granted permission to authorize emergency medical treatment, if necessary, and that such action by Institution shall be subject to the terms of this Agreement. I understand and agree that Institution assumes no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.

It is my express intent that this Release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my estate, family, heirs, administrators, personal representatives, or assigns, if I am deceased, and shall be deemed as a "Release, Waiver, Discharge and Covenant" not to sue the above-named Institution. I further agree to save and hold harmless, indemnify, and defend Institution from any claim by me or my family, arising out of my participation in the Activity or Trip.

By signing this Release, I acknowledge and represent that I have fully informed myself of the content of the foregoing waiver of liability and hold harmless agreement by reading it before I sign it, and I understand that I sign this document as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written statement, have been made. I understand that the Institution does not require me to participate in this activity, but I want to do so, despite the possible dangers and risks and despite this Release. I further state that I am at least eighteen (18) years of age and fully competent to sign this Agreement; and that I execute this release for full, adequate, and complete consideration fully intending to be bound by the same. I further state that there are no health-related reasons or problems which preclude or restrict my participation in this activity, and that I have adequate health insurance necessary to provide for and pay any medical costs that may be attendant as a result of injury to me.

I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR PARTICIPANT'S INJURY OR DEATH OR DAMAGE TO PARTICIPANT'S PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED ACTIVITY OR TRIP AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY PARTICIPANT'S NEGLIGENT OR INTENTIONAL ACT OR OMISSION.

Should Participant require emergency medical treatment as a result of accident or illness arising during the Activity or Trip, I consent to such treatment. I agree to be financially responsible for any medical bills incurred as a result of emergency medical treatments. I acknowledge that Institution does not provide health and accident insurance for participants in the Activity or Trip and I agree to be financially responsible for any medical bills incurred as a result of emergency medical treatment. I will notify Institution representatives in writing if Participant has medical conditions about which emergency medical personnel should be informed.

I further agree that this Release shall be construed in accordance with the laws of the State of Texas. If any term or provision of this Release shall be held illegal, unenforceable, or in conflict with any law governing this Release the validity of the remaining portions shall not be affected thereby.

I permit and authorize Texas Southern University (the “University”) and its employees, agents, representatives, contractors, and personnel who are acting on behalf of the University to create and/or obtain and use my photograph, my voice or quotes/excerpts of my written or verbally expressed words, my artwork or a photograph of my artwork, my name, alias, or biographical information, a video and/or recording of other likeness of myself (hereinafter collectively referred to as “My Likeness”) for purposes related to the educational mission of the University, including instructional and educational purposes, publicity, marketing, and promotion of the University and its various programs without compensation to me. I understand My Likeness may be copied /reproduced and distributed by means of various media, including but not limited to, video presentations, simultaneous television broadcast/rebroadcast, radio transmission, retransmission, news releases, mail-outs, e-mails, billboards, signs, brochures, placement on websites and/or electronic delivery, publication, display, on any and all other media, and I further understand that My Likeness may be subject to reasonable modification or editing. I acknowledge that the University has the right to make one or more photographs, audio recordings, videotape or disk presentations, or other electronic reproductions of My Likeness in accordance with this Authorization for Use of Image, Voice, Performance, Artwork, or Likeness, hereinafter sometimes referred to simply as “this Authorization”). I waive any right to inspect or approve the finished product or material in which the University may eventually use My Likeness.

I relinquish and give the University all rights, title and interest in and to My Likeness, including any copyright therein. This authorization shall be binding upon my heirs, successors, assigns, and legal representations.

I understand that, although the University will endeavor to use My Likeness in accordance with standards of good judgment, the University cannot warrant or guarantee that any further dissemination of My Likeness will be subject to University supervision or control. Accordingly, I release the University from any and all liability related to the dissemination, reproduction, distribution or illusionary effect of My Likeness, whether intention or otherwise, in connection with said use. I also understand that I may not withdraw permission for use of My Likeness that was granted with this Authorization.

I have read and understand the conditions of this Authorization for Use of Image, Voice, Performance, Artwork, or Likeness.

CONSENT OF PARENT/LEGAL GUARDIAN REQUIRED FOR MINOR

I am the parent and/or guardian of the above minor and hereby consent and agree to the foregoing terms and provisions on her behalf.

In consideration of the acceptance of my application for Project GAP, I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to my child as a result of their participation in Project GAP (Girls Achieving Power) summer camp.

The undersigned agrees to assume all risks, and recognizes that despite the exercise of reasonable safety precautions by Texas Southern University, injury is possible whenever one engages in physical activity.

This release is intended to discharge in advance Texas Southern University, its officials, camp officers, employees, volunteers, and agents from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that activities involve minimum or no risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assignees.

We expect your child to come to the TSU campus each day for Project GAP. Transportation is provided for each child who requires it or lives within a 5-mile radius of the TSU campus. If we are providing transportation for your child, we expect your child to be ready at the agreed-upon time.

If you are going to miss the day for any reason, please let Dr. Guinn or Dr. Meshack know ahead of time.

If you are having difficulties with connecting to Internet or virtual meetings, please email/text your mentor to let them know.

It is a good practice to try to login to your virtual meeting at least 5 minutes early to avoid any technical difficulties.

A girl with excessive tardies and/or absences may be asked to leave the program and replaced with a girl on the wait list.

Every child enrolled in Project GAP must be immunized against vaccine-preventable diseases caused by infectious agents in accordance with the immunization schedule adopted by the Texas Department of State Health Services.

Parents must provide valid written evidence from their treating physician (M.D. or D.O.) reflecting that either (1) all required immunizations have been received. The treating physician must be properly licensed and in good standing with the State of Texas. The physician’s signature or stamp must be present on the immunization record. The only exception to the foregoing requirement is a medical exemption signed by the student’s treating physician (M.D. or D.O).

Any student requesting a medical exemption must present a written statement to Project GAP, from their treating physician, stating that “in the physician’s opinion, the vaccine(s) required is medically contraindicated or poses a significant risk to the health and well-being of the child … or any member of the child’s household” (25 Tex. Admin. Code §97.62). The document must specify which vaccine(s) is included and state a specific and valid medical contraindication as defined in the Center for Disease Control and Prevention’s General Best Practice Guidelines for Immunization: Contraindications and Precautions.

Unless the physician states a lifelong condition exists, the exemption is valid for one year from the date signed. The treating physician’s license number must be reflected on the medical exemption documentation. Project GAP does not consider conscience-based exemptions or any other non-medical exemptions. Students with exemptions may be excluded in times of emergency or epidemic.

By enrolling in Project GAP (Girls Achieving Power), I, as a parent of this child, give permission to Project GAP to:

• Use PROJECT GAP (“the work”) submitted by my child, including (but not limited to) display, promotion, reproduction and distribution in all media and the right to create, perform, display and distribute derivative works;
• To edit the work;
• To use my child's name, likeness and biographical material in connection with the work.

I hereby certify and warrant that the information listed above is correct and that granting PROJECT GAP permission to use it.

I release Project GAP, its officers, directors, employees, sponsors, licensees, and successors from any liability or claimed liability in connection with my projects and contest submission. I acknowledge that I have read this consent and release prior to signing it and that I understand its contents.

Project GAP contributes to current research on youth enrichment and mentoring programs. Participants will be asked to fill out a survey prior to and at end of activities. Interested participants will be contacted for interviews after the competition. The data collected from the surveys and the interviews will be used for research purposes. The results of the research will be published and shared in conferences without identifying any students. Results also will be available through the official website of Project GAP. The participants' identities will remain confidential and not shared so that their names are known. Every effort will be made to ensure the confidentiality and privacy of the participants in this project.

We protect the privacy and rights of children online. We follow The Children’s Online Privacy Protection Act (“COPPA”) in our program. The Children’s Online Privacy Protection Act (“COPPA”) imposes certain requirements upon web sites and online services that are directed toward children (https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-reform-proceedings/childrens-online-privacy-protection-rule).

Project GAP is hosted by Texas Southern University College of Education Department of Health, Kinesiology, and Sport Studies. We value and protect the privacy and rights of children online and take measures to ensure that each participant’s individually identifiable information is protected. We do not collect any individually identifiable information directly from students whom we know are under the age of 13. In order to register your child to participate in our activities, we collect certain personal identifiable information and we require parental consent for participation. Any information collected is used for the sole purpose of registering participants to Project GAP (Girls Achieving Power) and is not shared with third parties or otherwise distributed. If you have any questions related to the use of individually identifiable information collected, please feel free to contact us.

I represent that I am a parent or legal guardian of the minor who has signed above and I hereby agree that we will both be bound thereby.

I also acknowledge and agree that by typing my name in the designated boxes on the screen below this form and clicking "Submit Questionnaire", I am electronically signing this CONSENT/ENROLLMENT form, which will have the same legal effect as the execution of this document by a written signature and shall be valid evidence of my intent and agreement to be bound by its terms.