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Student Information

Selected Value: 1
Student's Name

Parent Information

Parent/Guardian
Address
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Emergency Contact

Emergency Contact Name

Other

Health Concerns
Special Needs
Liability and Hold Harmless Agreement & Talent Release
In the event of an accident, illness, or injury, and the person listed above cannot be reached; I hereby give the program personnel
permission to take action as deemed necessary in the best interest of my child. Furthermore, I do not hold Bytes & Bots, its sponsoring
agencies, and/or its staff or representatives responsible for injuries to my child, which could occur due to the nature of the activity in
which my child is engaged. I also understand that the Bytes & Bots staff reserves the right to terminate the participation of any student
when it is deemed in the best interest of either the student or the summer camp programs.
I hereby consent to the use of any off and/or on camera performance and/or likeness of my child, with or without name, to be used by
Bytes & Bots for educational, research, advertising and marketing purposes without compensation for said use.