Board of Trustees and Supporters Donation - 2017/2018
I, Participant, waive, release and discharge JerseySTEM, Inc., its trustees, officers, employees, hosts and host facilities, from any claims, demands, costs, causes of action, or damage arising directly or indirectly as a result of property loss or damage, or personal injuries sustained to myself during my participation in or traveling to and from locations for activities [for the JerseySTEM program]
Furthermore, I intend this waiver and release to be legally binding on my heirs, executors, administrators, estate and assigns. In the event that JerseySTEM, Inc. or any trustees, officers, agents, employees, hosts or volunteers of JerseySTEM, Inc. provides transportation for me, this Waiver and Release shall extend to and release any volunteer driver or employee driver from any aforesaid liability.
In the event that I become ill or have any type of accident or other emergency situation concerning my health, safety or well being, I authorize JerseySTEM, Inc. to obtain the services of a licensed physician to treat and administer medication to me. By doing this I release and hold harmless JerseySTEM, Inc., its trustees, officers and employees, for any liability whatsoever that may result from negligence, nonfeasance or malfeasance that may arise as a result of the emergency and/or treatment.
I, the undersigned, hereby state that I am an adult over the age of eighteen (18) years, and that I am mentally competent to make this release. I will notify JerseySTEM, Inc. in writing if this status changes. Students under 18 must have the signature of a parent or legal guardian on this form. I further state that I am physically able to participate in the activities during the time period indicated above.
During the program, members of the program may take photographs of students, audiotape/videotape students, or interview students for JerseySTEM related stories in a way that would individually identify a specific student. Those photographs and/or audio/videotaped images or interviews may appear in district publications; in district video productions; on the district Web site; in the news media. I hereby grant unto JerseySTEM permission to use my child’s photograph and/or videotaped image for the purposes mentioned above. I understand and agree that JerseySTEM may use these photos and/or videotaped images on social media platforms, websites and other platforms. I further grant unto JerseySTEM permission to allow my child to be photographed, audio/ videotaped, or interviewed by the news media or other organizations for JerseySTEM-related stories or articles.
I hereby release, indemnify and hold harmless the organizers, sponsors, the visited orgainzation and supervisors of all its activities from any and all liability in connection with the programs (including any injury caused by negligence) in conjunction with any trip opportunity or organization. I likewise hold harmless from liability any persons related to this activity.
Participants are expected to:
Respect of public and private property, submission to the authority of the organizers, courtesy in actions and language, speak in turns (raise hand before speaking), appropriate attire, remaining with the group and being alert and purposeful.
JerseySTEM reserves the right to cancel the programs in case of low attendance or other reasons. JerseySTEM will reimburse the attendees of the registration fee collected by JerseySTEM.
Where can I contact the organizer with any questions?
36 Chatham Road, Summit, 7901, NJ, United States