ROAR'22: Parent Consent Form - Required

Required Parent Consent Form -
A parent or legal guardian of each student participating in ROAR (July 15-16) must complete this form by/before July 15.

Thank you - If you have any questions, please contact the Admissions Office at 770-534-6100.

Parent or Guardian Information

First

Last

Mobile Phone Number

Student Information

First Name

Last Name

Email Address

Birthdate

Brenau University Release Form:

The undersigned hereby releases and discharges Brenau University and participating faculty from all liability for negligence or responsibility for loss or damage to the person or property of the student arising out of or in connection with the program.

The undersigned chooses to assume all risk associated with the program, including any risk inherent in transportation to and from the place where the activity is to occur. Whether as a driver of my own vehicle, or as a passenger in another vehicle.
I understand the vehicle driver’s automobile insurance becomes the primary source of any recourse for claims of liability should an injury/accident occur.
I understand that I am solely responsible for any medical treatment I may need as the result of participation in this program and that Brenau University does not provide medical/health insurance for this program.

I have read and understand the terms of this agreement. The student and I have signed this form freely and voluntarily with full knowledge and consent of its terms and without any fraud, duress, or coercion.

Parent/Guardian Signature

Today's Date

Student Signature

Today's Date

Emergency & Medical Information

Please list any medical information related to medical conditions that are relevant to this event or for which special accommodations may be required (including medications or allergies):

Emergency contact name(s) and number(s)