PARENT/GUARDIAN CONSENT, RELEASE AND WAIVER OF LIABILITY FORM

Parent/Guardian Information

Volunteers Under Age 18

Parent/Guardian Name: ___ Relationship to Volunteer: ___

Phone Number: ___ Email Address: ___

Consent to Participate

□ I, the undersigned parent or legal guardian of the above-named volunteer, hereby give my consent for my child to participate in volunteer activities at Kentucky State University (KSU).

Acknowledgment of Risk

□ I understand that volunteering may involve certain risks, including but not limited to physical injury or property damage. I freely and voluntarily assume all such risks on behalf of my child.

Release of Liability

□ On behalf of my child, I hereby release, waive, and discharge Kentucky State University, its trustees, officers, employees, and agents from any and all liability, claims, demands, or causes of action arising from participation in volunteer activities, including claims arising from negligence.

Medical Treatment Authorization

☐ In the event of an emergency, I authorize KSU personnel to secure medical treatment for my child as deemed necessary. I understand that I am responsible for any medical expenses incurred.

Allergies or Medical Conditions (if any):

___

Photography and Media Release

□ I grant Kentucky State University the right to take photographs, video recordings, or other media of my child during volunteer activities and to use such media for educational, promotional, or public relations purposes without compensation.

Certification and Signature

I certify that I have read this form, understand its contents, and agree to be bound by its terms on behalf of my child.

Parent/Guardian Signature: ___ Date: ___

Revised: September 2025