Please fill out this form for each child interested in attending.
My child desires to participate in a Real Life ALC sponsored field trip and/or special event as a part of a comprehensive and diverse learning environment. I realize that they may be traveling in a group or independently, off-campus. As a part of the trip/event my child's picture or voice may be recorded (photo release form is below.) Field trip/event participants are expected to conduct themselves in a positive manner as representatives of Real Life ALC, and agree to adhere to instructions from Real Life ALC staff and facilitators while off-campus.
Please enter the name of the field trip your student is interested in attending.
Please include all location information known about this activity, including city and state- especially if not in Tampa, Florida.
List any risks specific to this trip- i.e.: air travel, vehicle travel, foot travel, certain physical or outdoor activities, equipment, special environments or exposures, etc)
II. LIABILITY WAIVER / RISK ACKNOWLEDGEMENT
I understand that my/my child's participation in trip activities could involve risk of physical injury, illness, death or property loss, and despite safety precautions, Real Life ALC cannot guarantee safety thereof, as all risks cannot be prevented. Real Life ALC does not provide health and accident insurance for trip participants, and I understand that any medical expenses, property loss, or other personal expenditures that result during or from this travel/trip are to be borne by the student/participant, or by their parent or guardian (if student/participant is a minor). Depending on the destination, Real Life ALC may require trip travel insurance, which would be obtained by Real Life ALC through an insurer with the cost being included in the cost of the trip. The traveler will be advised if this insurance is required. I also hereby consent and give authorization to trip leaders to secure any emergency medical treatment for my child, and I agree to be responsible for the costs thereof.
I further acknowledge that if I/my child drive/s my/their own vehicle, or am/is a passenger in another’s private vehicle in connection with this trip/function, that Real Life ALC’s auto insurance does not cover any occurrence resulting from student’s travel in said private vehicle. I also understand that Real Life ALC cannot be responsible for assuring the safety and reliability of such private transportation or driver or for any non-sponsored activities and travel that I/my child choose/s to participate in before, during or after the Real Life ALC sponsored function, and I therefore accept the risks and responsibilities associated with such private vehicle travel.
In consideration of the opportunity afforded, with full knowledge and voluntary acceptance of the risks associated with this travel and the trip activities, and with full understanding of the above issues/conditions, I for myself (for my child), family, estate, successors, and assigns, do hereby fully and unconditionally, forever release and hold harmless Real Life ALC, its staff, facilitators, officers, employees, agents, directors, volunteers, successors, assigns from claims, causes of action, suits, liabilities, damages, losses, demands, costs, expenses, or judgments, for damages or injury arising from my child’s participation in this activity/program. I also have read and explained these stipulations to my child, and my child agrees to abide by them.
III. EMERGENCY CONTACT INFO
Please provide an emergency contact in the event you are not reachable in an emergency.
IV. IMAGE AND AUDIO RELEASE AND AUTHORIZATION
I, the parent or guardian of the above named Real Life ALC student, hereby consent for Real Life ALC, its facilitators, officers, employees, agents, directors, volunteers, successors, and assigns including independent third party photographers hired by Real Life ALC, to record my picture and voice on photographs, films and audio and videotapes, to edit these recordings at the discretion of Real Life ALC, and to incorporate these recordings into movie and sound films or audio and videotapes, webcast, streaming, social media sites, broadcasts, (radio and television, including cable and satellite transmissions), programs or otherwise, to use in any manner of media whatsoever, including unrestricted use for purposes of publicity, advertising, and to use my name, likeness, or voice in connection therewith.
I hereby release Real Life ALC from any and all claims for damages, for libel, slander, invasion of privacy or any other claim based on the use of the above-described materials. I further waive any rights conferred under federal copyright laws or any other rights I might otherwise have in the materials and the subsequent broadcast or commercial, educational, or other use by Real Life ALC. I understand that the recordings are the exclusive property of Real Life ALC, and Real Life ALC owns all rights to these recordings regardless of the form in which they are produced or used. Further, I agree that I am not entitled to nor was I promised any compensation for the making of such recordings or their use.
By clicking "Submit", I hereby affirm that I am the parent or legal guardian of the above named student, and that the information I have provided on this form is true.