2019-2020 Virtual Sanctioned Event Waiver, Release and

Permission Form
Form Facts
What: Attendees of Virtual Sanctioned Events must read and sign this form in order to participate in these
Events. This document is a release of liability and a waiver of certain rights.
Who: Attendees of Virtual Sanctioned Events must read and sign this form.
Why: This form is necessary in order to attend Virtual Sanctioned Events.
Where: Submit this form to your Connections Academy school (the “School”) via your Community
Coordinator or School official.

Notice to Responsible Parties

Virtual Sanctioned Events are an important part of the Connections Education educational experience. They
extend and enrich the standard curriculum and provide additional learning opportunities for students. We will
be participating in an Event facilitated with technology, specifically the Internet, World Wide Web and utilizing
the LiveLesson® session format.

In order to participate in the Virtual Sanctioned Event (“Event”), each participating adult must be named and
sign this form, and each attending minor child must be named and have an adult sign for them. Children over
the age of 18 and emancipated minors are to sign this Waiver, Release and Permission Form for themselves.

In consideration for being allowed to participate in the event, you agree to the following for yourself
and the minor child(ren) listed:

● You voluntarily agree to participate and/or allow the child(ren) who you are supervising, and who
are listed below, to participate in the Event.
● You acknowledge that there are inherent risks associated with the Event such as those related to
the use of the Internet and World Wide Web and that not all risks can be prevented. You agree to
assume and accept all risks associated with the Event for yourself and the participating child(ren)
and agree to at all times supervise the participating minor child(ren) or designate another adult to
supervise the participating minor child(ren) unless special permission has been obtained from the
school.

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● You understand that any information, including personally identifiable information, that you or the
student submits in a LiveLesson session for the Event will be disclosed and available to all
participants, and if recorded, available to additional users, and is therefore no longer private even if
you have opted out of the FERPA Directory Information policy. We cannot guarantee the security of
such information that you disclose, and you do so at your own risk. By participating, you agree to
these above terms.
● You willingly agree to comply with the stated and customary terms noted in the Connections
Academy School Handbook and conditions for participation in the Event. If, however, you observe
any unusual significant hazard during your or your child(ren)’s presence or participation, you will
remove yourself and/or your child(ren) from participation and immediately bring such to the
attention of the school staff.
● You for yourself, your child(ren), heirs, assigns, personal representatives and next of kin agree to
release and hold harmless the School and Connections Education LLC, and their subsidiaries,
affiliates, directors, officers, employees, agents, and volunteers from all claims, injuries, actions,
causes of action, liabilities, suits and expenses which are related to, arise out of, or are any way
connected with you or your child(ren) participating in the Event, and also applies to any present or
future injuries and binds my heirs, executors, and administrators.

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2019-2020 Virtual Sanctioned Event Waiver, Release and
Permission Form
Form Facts
What: Attendees of Virtual Sanctioned Events must read and sign this form in order to participate in these
Events. This document is a release of liability and a waiver of certain rights.
Who: Attendees of Virtual Sanctioned Events must read and sign this form.
Why: This form is necessary in order to attend Virtual Sanctioned Events.
Where: Submit this form to your School via your Community Coordinator or School official.

Event Details

Name of Event: Virtual FT: Geometry in Nature School: CalCA

Description of Event: Did you know math can be

found in a seashell, a honeycomb or a leaf?
Investigate the patterns and shapes that can be
observed every day in nature.
Region:Virtual On this Virtual Trip we will be at the Liberty Science Center in
Jersey City, NJ. The Liberty Science Center’s dynamic
instructors will engage the learners in an exploration of
Geometry in Nature. This event will be broadcasted live from
the lab in the Jennifer A. Chalsty Center for Science Learning
and Teaching!

Start Date/Time: 10/22/19, 10:00 am PST End Date/Time: 10/22/19, 11:30 am PST

CC or Staff Member in Charge of Event: Chris

Other:
Thompson

Attendee Signatures
List all individuals who will be attending the Virtual Sanctioned Event along with you. List yourself as well. Each
adult attendee, child over 18, and emancipated minor should sign next to his or her name. Each minor must
have his or her parent/legal guardian/adult designee sign for him or her. It is understood that the signature of
one parent/legal guardian/adult designee below implies the consent of the other.

By signing below, I acknowledge that I have carefully reviewed, read, and understand all pages of the Virtual
Sanctioned Event Waiver, Release and Permission Form (found in the Virtual Library at Community

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Coordinators > Event Information and Forms > Virtual Sanctioned Event Waiver, Release and Permission
Form). By signing below, I agree that I have carefully read all pages of this form, understand all of its terms,
and sign it freely and voluntarily without any inducement, and with full knowledge of its significance.

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 Name of Event: Virtual FT: Geometry in Nature

Location of Event: Virtual – LiveLesson Classroom

Name of Attendee Signature of Attendee Attendee’s Role (check one)

☐Adult Designee ☐Parent/Legal Guardian
☐CE Student ☐Other:
☐Adult Designee ☐Parent/Legal Guardian
☐CE Student ☐Other:

☐Adult Designee ☐Parent/Legal Guardian

☐CE Student ☐Other:

☐Adult Designee ☐Parent/Legal Guardian

☐CE Student ☐Other:
☐Adult Designee ☐Parent/Legal Guardian
☐CE Student ☐Other:
☐Adult Designee ☐Parent/Legal Guardian
☐CE Student ☐Other:
☐Adult Designee ☐Parent/Legal Guardian
☐CE Student ☐Other:
☐Adult Designee ☐Parent/Legal Guardian
☐CE Student ☐Other:
☐Adult Designee ☐Parent/Legal Guardian
☐CE Student ☐Other:

☐ I do not consent to the use of names, photographs, and/or video taken of the above listed participants in
connection with this event in my school’s publications and marketing and promotional materials.

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