PARENTAL CONSENT FORM
Required for all participants under the age of 18
Participant Contact Information
Date of Birth: ______________ Graduation Year: __________
Email Address: _______________
Home Address: ______________________________
City: _______________ State: __________ Zip: __________
PARENT/GUARDIAN INFORMATION (Emergency Contact):
Name: _______________ Relationship: _______________
Email Address: ____________________ Phone: _______________
Address (If different from above): ______________________________
In consideration for the admission of this junior participant in any activity at the Ozark Dynamics Training Facility, I hereby:
Give my permission for this Junior’s participation.
Release Ozark Dynamics, LLC and ACE Tomato Company, LLC and any other organization sponsoring or supporting such activity (including all directors, officers, employees, agents, and volunteer workers) from any claim or liability that may arise directly or indirectly from this Junior’s presence or participation in the activity.
Agree to defend, indemnify, and hold harmless the parties referred to in Item 2 above from any claim arising from any wrongful or negligent conduct by the Junior.
Agree that photographs of the participant taken during any events conducted at the Ozark Dynamics Training Facility and the competition results (if any) may be published or reproduced by Ozark Dynamics, LLC in its printed or electronic communications.
Junior Participant Signature: _______________________________
Parent/Guardian Signature: ________________________________