2018-2019 Sanctioned Event Waiver, Release and Permission

Form
Form Facts
What: Attendees of Sanctioned Events must read and sign this form in order to participate in these
Sanctioned Events. This document is a release of liability and a waiver of certain rights. To request disability
accommodations for an Event, contact the community coordinator at least 10 days prior to the Event.
Who: Attendees of Sanctioned Events must read and sign this form.
Why: This form is necessary in order to attend Sanctioned Events.
Where: Submit this form to your Community Coordinator or School official.

Notice to Responsible Parties

Sanctioned Events are an important part of the Connections Education educational experience. They extend
and enrich the standard curriculum and provide opportunities for socialization between students and their
families. All Events require all students—whether enrolled in a Connections Academy school (the “School”) or
otherwise (hereinafter collectively "child(ren)")—to be accompanied by a responsible adult who is a
parent/legal guardian or an adult designated by the parent/legal guardian*. Participants must adhere to
guidelines provided by the Community Coordinators, School staff, and Connections Education.

If you are the adult designee, where the parent/legal guardian is not attending, you must be authorized by the
parent/legal guardian to attend the Event with the child(ren) you are supervising and to execute this Waiver,
Release and Permission Form, attached hereto, for the minor child(ren). Each participating adult must be listed
on and sign this form. Each attending minor child must be listed on this form and have an adult sign for him or
her. Children over the age of 18 and emancipated minors can sign the form for themselves, but they must still
be supervised by a parent/legal guardian or adult designee*.

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 certain risks inherent in Sanctioned Events and that not all risks
can be prevented. You agree to assume and accept all risks associated with participating in the
Sanctioned Event for yourself and the participating child(ren) and agree to at all times supervise the
participating child(ren) or designate another adult to supervise the participating child(ren)*.

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  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 Sanctioned Event, including any accident or incident en route
to, during, or returning from or which is related to, arises out of, or is in any way connected with the
Event and also applies to any present or future injuries and binds my heirs, executors, and
administrators.
 In securing emergency aid, the School will rely on the medical information provided by the
parent/legal guardian/adult designee, in the emergency contact information, and in the student health
information sections in Connexus. You agree to notify the Community Coordinator or School staff
member in charge of the event in writing if your child(ren) has/have a medical conditions or allergies not
detailed in the student health information sections in Connexus about which emergency medical
personnel should be informed. You consent to the School securing emergency medical treatment as a
result of accident or illness arising during the Sanctioned Event, including contacting 911 and
performing any first-aid/medical treatment deemed necessary for the health of the participating
child(ren). This authority is granted only after a reasonable effort has been made to reach the
emergency contacts.
 You willingly agree to comply with the stated and customary terms and conditions for
participation in the Sanctioned 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 acknowledge that the School and/or Connections Education is not financially responsible
for emergency care and/or related transportation for you or the participating child(ren) and you agree to
be financially responsible for any medical bills incurred as a result of emergency medical treatment.

* Students who are 18 years or older or are emancipated minors may gain permission to attend an Event
unsupervised by a parent/legal guardian or adult designee, contingent upon the completion by the parent/legal
guardian or adult designee of the “Connections Education Student Driving and Attendance Form”, and the
approval of that form by the school’s principal or his/her designee.

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800-382-6010 | Connections Education.com | © 2018 Connections Education LLC. All rights reserved.
2018-2019 Sanctioned Event Waiver, Release and Permission
Form
Form Facts
What: Attendees of Sanctioned Events must read and sign this form in order to participate in these
Sanctioned Events. This document is a release of liability and a waiver of certain rights. To request disability
accommodations for a Sanctioned Event, contact the community coordinator at least 10 days prior to the
Event.
Who: Attendees of Sanctioned Events must read and sign this form.
Why: This form is necessary in order to attend Sanctioned Events.
Where: Submit this form to your Community Coordinator or School official.

Event Details

Name of Event: Click here to enter text. School: Click here to enter text.
Region:Click here to enter text. Description of Event:Click here to enter text.

Start Date/Time: Click here to enter text. End Date/Time: Click here to enter text.
CC or Staff Member in Charge of Event: Click here Other: Click here to enter text.
to enter text.

Attendee Signatures
List all individuals who will be attending the Sanctioned Event along with you. List yourself as well. All
attendees should sign next to their name. Minors must have their parent/legal guardian/adult designee sign for
them. It is understood that the signature by one parent/legal guardian below implies the consent of the other.

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

Name of Event: Click here to enter text.

Location of Event: Click here to enter text.

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800-382-6010 | Connections Education.com | © 2018 Connections Education LLC. All rights reserved.
 Name of Event: Click here to enter text.

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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800-382-6010 | Connections Education.com | © 2018 Connections Education LLC. All rights reserved.