ISU FLL Consent and Release Form 2022-2023

Iowa State University of Science and Technology

Participation Agreement

Assumption of Risk, Release and Waiver of Liability, and Indemnification

PLEASE READ THIS PARTICIPATION AGREEMENT, ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY AND INDEMNIFICATION DOCUMENT CAREFULLY. It is a legal contract and affects any rights you/your child may have if you/your child is injured or otherwise suffers damages while participating in the below-referenced program at ISU. Parents and legal guardians of minor participants are responsible for carefully reviewing all program materials and for selecting programs that are appropriate for their child.

Program Description

ISU Department Name: College of Engineering, Engineering Outreach and Talent Development Programs

Program Title: FIRST® LEGO® League

Dates of Participation: FLL Season 2022-2023

Supervisor: Yamille Perez

Location: Virtual or In-person at FLL Qualifiers, Championships, or FLL Expos in Iowa


FIRST LEGO League Challenge and FIRST LEGO League Explore are both international programs created by FIRST and LEGO to get children interested in and excited about science, technology, and engineering. Every year FIRST releases a new challenge that engages the teams in hands-on robotics design and scientific research. The theme for the challenge is different each year, allowing teams to learn about a variety of subjects.

Please use full legal name.

If participant is under 18 years of age, Parent/Guardian Name (full legal name)

Phone
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Demographic Survey

A summary of the data collected will be used for grant applications in an effort to keep our program fees as low as possible.


Information collected will remain confidential. Thank you!

The Participant identifies as:*

The Participant identified in this document (“Participant”) desires to voluntarily participate (as a team member, coach, mentor, judge, or in some other manner) in the FIRST LEGO League or other FIRST program (“Program”). As a condition of and inconsideration for allowing Participant to participate in a Program, Iowa State University, on behalf of its College of Engineering(“University” or “ISU”), requires that the Participant (and the Participant’s parent/legal guardian if under 18 years of age) agree to the terms of this PARTICIPATION AGREEMENT, ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNIFICATION DOCUMENT. For participants under 18 years of age, “Participant” is understood to include their parent/legal guardian. By signing this document, Participant agrees to the following:


Behavior and Conduct Expectations

It is important to follow the directions of Iowa State University personnel in charge of the Program and ISU volunteers at all times.Participant agrees to abide by the Program’s rules and conduct expectations. Participant understands and agrees that as a participant, they have the responsibility to help make the Program a safe experience for everyone through their behavior and conduct. Participant acknowledges and accepts that ISU employees and volunteers have undergone background checks, but other participants of the Program may not have undergone background check screening. As such, ISU makes no assertions or assurances with respect to other participants.


Image/Voice Permission

During Program activities, a photograph or video/audio recordings may be taken of Participant. By voluntarily participating in theProgram, Participant agrees and grants Iowa State University full permission to photograph, film, audio/video tape, record and/or otherwise capture Participant’s image and/or voice. In addition, during virtual programs, your location, setting, or other personal information may be electronically captured and displayed. Unless you request otherwise, your initials below will be considered permission for Iowa State University and the faculty, staff, and event volunteer in charge to photograph, film, audio/video tape, record and/or televise your image and/or voice. Further, the Participant agrees that Participant’s image/voice may be used in any publications or promotional materials, in any medium now known or developed in the future, without any restrictions and without any additional consideration. If you object to ISU using your image or voice in this manner, please notify the program faculty or staff prior to participating.


Medical Emergency Contact Information

In the event of an emergency, ISU or the volunteer event host will attempt to contact the emergency contact for the team that being the coach(es) in charge of the team.


Medical Emergency Permission and Waiver

I understand that Participant must be healthy and reasonably fit in order to safely participate in this Program. Participant understands and attests that they have assessed the Program and Participant’s health and fitness and voluntarily select to participate. Participant understands and accepts that the supervisor/program leader(s)/volunteer is not responsible for monitoring or administering any medication or ailment or condition of Participant. I also understand that during virtual programs that I am solely responsible for monitoring my health and condition.


If an injury or other medical condition occurs or arises, Participant hereby gives permission to ISU personnel and ISU volunteers to seek medical treatment or service, including without limitation: first aid, hospitalization, and emergency ambulance service forParticipant in connection with Participant’s participation in the Program. Participant agrees to the release of any record necessary for treatment, referral, billing or insurance purposes. In the event of an emergency where the Emergency Contact(s) (Team Coach)cannot be reached and/or timing does not allow, Participant hereby gives permission to the physician/hospital selected by the ISU personnel in charge or ISU volunteer to secure and administer treatment, including without limitation hospitalization and other services deemed medically necessary. Participant understands and accepts that ISU does not provide health insurance or other coverage for Participant. Accordingly, Participant understands and agrees to be financially responsible for any costs incurred as a result of any medical or health treatment and services, and hereby agrees to make full payment for such to the attending medical personnel and/or health care facility rendering such treatment and services. In addition, if the event is virtual and an injury or other medical condition occurs or arises, the Participant understands that ISU will not be available to assist or arrange for assistance.


Assumption of Risk, Release and Waiver of Liability, and Indemnification Agreement (Read Carefully)

Participant understands that Participant’s participation in the Program is entirely voluntary and that as a condition of and inconsideration for Participant’s participation in the Program, Participant accepts and agrees to all of the terms and conditions of this Participation Agreement.


Assumption of Risk: Participant understands and accepts that as part of Participant’s participation in the Program that there are dangers, hazards and certain risks, both known and unknown, to which Participant may be exposed, including the risk of serious physical injury, temporary or permanent disability, and even death, as well as economic and property damage/loss. In addition, because there is an inherent risk of exposure to COVID-19 or any other communicable disease in public places where other people are present, infection and illness from COVID-19, or other communicable diseases, is a known risk of participation in the Program.Similarly, for a virtual event, the Participant understands the potential risks associated with participation in online Program activities. The Participant understand that Program staff are not providing supervision for the Participant during the online program, and the University does not have control over the information available through the internet or other electronic datasources. Sites accessible through the internet or other electronic data sources may contain material that is illegal, defamatory, inaccurate, obscene, profane, or potentially offensive to others. The risks may include, but are not limited to: “Zoombombing” or other similar disruptions, cyber bullying, identity theft, hacking, intentional or inadvertent exposure to the types of materials described above, exposure to potentially triggering subject material in writing, art, or spoken word, personal injury including death, and loss or damage of personal property. Participant understands and accepts that ISU cannot guarantee that Participant will remain free of injury or damage, nor eliminate the known and/or unknown risks. By agreeing to participate, Participant voluntarily accepts and assumes all risks associated with participation in the Program.


Release and Waiver of Liability and Indemnification Agreement: Further, to the fullest extent permitted by applicable law,Participant agrees, for themselves, their heirs, personal representatives and assigns, to RELEASE from LIABILITY, HOLD HARMLESS,DEFEND and INDEMNIFY, the State of Iowa, the Board of Regents ‐ State of Iowa, Iowa State University, and their respective affiliates, officers, employees and agents (herein after referred to as “RELEASEES”), from and against any and all liability whatsoever (including all liability arising directly or indirectly from the negligence of RELEASEES) for any and all damages, losses or injuries (including death), Participant sustains to their person, property or both, including but not limited to any claims, demands, actions, causes of action, judgments, damages, expenses, costs, and attorney fees, which arise out of, result from, occur during or are in any way connected, directly or indirectly, to Participant’s participation in the Program. This release includes claims based on the negligence of RELEASEES to the fullest extent permitted by applicable law, but does not include claims based on the intentional misconduct or gross negligence of RELEASEES. Participant also agrees to RELEASE from LIABILITY, HOLD HARMLESS, DEFEND and INDEMNIFY the RELEASES from and against any and all liability whatsoever for any and all damages, losses or injuries (including death), Participant may cause or inflict on another person, or another person’s property or both, including but not limited to any claims, demands, actions, causes of action, judgments, damages, expenses, costs, and attorney fees, which arise out of, result from, occur during or are in any way connected, directly or indirectly, to Participant’s participation in the Program.


Governing Law: This Agreement is governed by and construed under the laws of the State of Iowa without regard for principles of choice of law. Any claims, demands, or actions arising under this Agreement must be brought in a proper court in the State ofIowa. In the event any one or more of the provisions contained in this Agreement shall for any reason be held to be invalid, illegal or unenforceable in any respect, such invalidity, illegality, or un-enforceability shall not affect any other provision of thisAgreement, but this Agreement shall be construed as if such invalid or unenforceable provision had never been contained. Further, in the event that any provision of this Agreement shall be held to be unenforceable by virtue of its scope, but may be made enforceable by a limitation thereof, such provision shall be deemed to be amended to the minimum extent necessary to render it enforceable under the laws of the jurisdiction in which enforcement is sought.

PARTICIPANT (AND THE PARENT / LEGAL GUARDIAN OF PARTICIPANT UNDER 18 YEARS OF AGE), BYTHEIR SIGNATURE BELOW, AFFIRMS THAT THEY HAVE CAREFULLY READ THIS PARTICIPATIONAGREEMENT, INCLUDING THE ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, ANDINDEMNIFICATION PROVISIONS, UNDERSTAND ITS CONTENTS AND PURPOSES, AND VOLUNTARILYAGREES TO ALL THE TERMS SET FORTH ABOVE.

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