Liability & Consent Form

I voluntarily consent to the Susie Brannon McJimpsey Center Inc interviewing my child(ren)'s teacher(s) and collecting information from my child's school records, and if applicable, his/her confidential school folder. I also agree to the collection of court and police records. This consent is valid until the child(ren) is/are the age of majority.

I hereby fully release and discharge the Susie Brannon McJimpsey Center Inc and its officers, agents, volunteers, and employees from any and all liability, actions, debts, claims, damage or loss which I may have or which accrue to me through my or my child(ren)'s participation in said programs. I further agree to indemnify and hold harmless the Susie Brannon McJimpsey Center and its officers, agents, volunteers, and employees from any and all injuries, damages or losses sustained by me and arising in any way from my or my child's participation in said programs held in the center and away. All participants in any sports or athletic activities are required to have a sports physical before they are allowed to participate. The physical is solely the responsibility of the parent or guardian or participants.

I hereby grant the Susie Brannon McJimpsey Center Inc or those whom they are acting as agents on behalf of the Susie Brannon McJimpseyInc the right and permission to copyright and/or publish written work, photography, portraits, videos, or pictures in which may be included in whole or in part of composite or reproductions thereof in color or otherwise made through any media or photography for art, advertising, trade or other similar lawful purpose whatsoever including but not limited to television, internet, and product packages.

I hereby release and discharge the Susie Brannon McJimpsey Center Inc, its successors and all persons acting from any liability by virtue of any blurring distortion, alteration , optical illusion taking of said picture in any processing tending toward the completion of the finished product(s).

I hereby grant permission for me or my child(ren)/ward to be transported as a passenger to and from activities sponsored by the Susie Brannon McJimpsey Center Inc.

I hereby grant permission for me, my child(ren)/ward to be tested, assessed, and tutored and participate in all lawful activities sanctioned by the Susie Brannon McJimpsey Center Inc.

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Parent/Guardian /Applicant Signature Date