Science Olympiad

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Student Information

Student's Name*
Gender*

Parent/Guardian Information

Guardian Name*
Guardian Address*
Emergency Contact Name*
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Acknowledgement of Policies and Consent

Liability and Photographic Release

I agree to indemnify and hold harmless the Carlsbad Educational Foundation (CEF) and the Carlsbad Unified School District and their officers, agents, or employees from any liability claim or action resulting from or in any way rising out of the participation in this activity by the registered person.

Liability*

I also permit CEF to use and publish photographs and/or video of my child for the purpose of promoting robotics and the work of the Carlsbad Educational Foundation.

Photo Release*
In the event that my child experiences a severe, life-threatening anaphylactic (allergic) reaction during a CEF program, I...*
for a trained/designated school staff member to administer the EpiPen emergency treatment, under indirect supervision of the school nurse. In the event the parent/guardian cannot be reached, permission is hereby given for the physician designated below to provide emergency care for my child should serious illness/injury occur at a FLL practice or event.
If applicable:
minor/student, I hereby authorize the principal or his/her designee, into whose care the aforementioned minor student has been entrusted, to consent to any X-ray, examination, anesthetic, medical or surgical diagnosis, treatment and/or hospital care to be rendered to said minor/student upon the advice of any licensed physician and/or dentist. I understand that this authorization is given in advance of any required diagnosis, treatment, or hospital care and provides authority and power to the aforementioned agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which a licensed physician or dentist may deem necessary. This authorization shall remain effective for the full robotics program unless revoked in writing and delivered to said agent(s). I understand that CEF, its employees and its Board assume no liability of any nature in relation to the transportation or treatment of the said minor/student. I further understand that all costs of paramedic transportation, hospitalization and any examination, X-ray or treatment provided in relation to this authorization shall be my responsibility.

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