Voluntary Disability Disclosure - Optional

Does the participant have a learning difference, physical disability, or receive accommodations in school that we should know about for the purposes of this program? Providing this information will help us to offer your child a positive experience while they are participating.

WPI is committed to ensuring all such information remains confidential as required or permitted by law. Information will only be shared with faculty and staff on a need-to-know basis.

PARTICIPANT WAIVER AND PERMISSION

General Liability Release

i. General Liability Release. My child and I have read and understand the inherent risks involved in the Program. My child and I understand that these risks exist despite the safety precautions and procedures implemented by WPI. I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE WPI and the Related Parties from any and all liability, claims, demands, actions, and causes of action whatsoever arising out or related to my child’s participation in this Program or transportation to and from campus, whether caused by the negligent act or omission of WPI, or otherwise. It is my express intent that this General Liability Release shall bind the members of my family, my heirs, assigns and personal representatives, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, and COVENANT NOT TO SUE WPI and the Related Parties.

ii. I hereby give my consent for my child to join in this Program. I warrant that he/she is fit and able to participate in all activities without undue risk. There is and will be adequate health insurance coverage in force for the term of his/her attendance. I further verify that the health insurance covers any and all accidents, injuries or illnesses that may result from participation in WPI activities.

My child and I agree to obey all rules and policies mandated by WPI personnel, including in WPI’s Code of Conduct, Acceptable Use Policy, Privacy Policy, and any WPI COVID-19 protocols. My child and I will not photograph, videotape and/or audiotape ourselves or others during this Program.

Photo, Media, and Copyright Release

I grant my permission for WPI to photograph, videotape and/or audiotape myself or my child during the Program. These photographs/videos/audios will remain the property of WPI and may be used in advertising or marketing campaigns on WPI’s websites, and for promotional and informational material including, but not limited to, flyers, brochures, newsletters, emails, advertisements, newspaper articles, TV or cable interviews/promotions. I understand my child will not be identified by name unless I give my express permission. I hereby waive and release on behalf of myself and/or my child, any rights to compensation for, or ownership of, such images and/or sounds.

Online Programs Release

This program includes some programming offered online. I hereby give my consent for my child to participate in all online portions of this Program, including lectures, group meetings, team projects, one-on-one office hours, and other programming with WPI faculty, staff, and students.

WPI uses several computer applications and web-based services operated by third parties (web-operators), such as Zoom, Canvas, and similar educational programs. In order for my child to use these applications and services, certain basic personal identifying information must be provided to the web-operator. These web-operators must notify parents/guardians and obtain parental consent before collecting personal information from children under 13 years old, but the law permits schools, like WPI, to consent to the collection of personal information on my behalf. I hereby grant my permission for WPI to provide limited personal identifying information for your child to the following web-operators, Zoom, Canvas, and any additional educational computer applications and web-based services that WPI may deem necessary.

Medical Release

I give permission for WPI program staff to (1) conduct COVID-19 screenings including visual inspections and temperature checks (if needed); (2) provide routine healthcare, first-aid, and seek emergency medical treatment on my behalf; and (3) arrange for medical transportation, if necessary, for my child.

I hereby give permission for medical personnel selected by WPI's designated healthcare/emergency staff to secure and administer medical treatment including hospitalization, order and administer medications, anesthesia, X-rays, surgery or special procedures if deemed medically necessary for my child during the duration of the program. I hereby understand that all medical costs are my financial responsibility and agree to pay for all charges associated with procuring or providing medical care for my child.

This is to certify that I, as parent/guardian with legal responsibility for the child registered, do consent, and agree to all of the provisions of this Participant Waiver and Permission Form, and for myself, the individual registered, and their heirs, assigns, and next of kin, I release and hold harmless WPI and the Related Parties from any and all liabilities related to my minor child’s participation in this Program.

Parent/Guardian Signature

By typing your full name and today's date here, you certify that you are the parent/legal guardian of the participating child and that the information contained on this page is accurate and complete:

Parent Signature

Date

Register

Please click the SUBMIT button to register.

Online Programs Release Value

This is hidden and conditional to Online Programs Release and will show the correct output in the formula

WPI Girls Who Code Registration