AMARILLO CHAPTER

TEXAS ALLIANCE FOR MINORITIES IN ENGINEERING

An affiliate of the Texas Alliance for Minorities in Engineering, Inc.

      RELEASE FORM

 ____________________________________________________, my daughter/son, has my permission to participate with the Amarillo Chapter of TAME, in the__________________________________________ In consideration for my daughter/son's participation with the Amarillo Chapter of TAME, in the _________________________________________on ___________________________,  I hereby waive and release the Amarillo Chapter of Texas Alliance for Minorities in Engineering and the Texas Alliance for Minorities in Engineering Inc.,(TAME) and their member organizations and affiliates from all liability and expense, without limitation and without regard to the cause or causes, for actual or alleged claims, damages, and injury.  I further agree to hold the Amarillo Chapter of TAME and TAME Inc. harmless  without limitation as to amount, against all liabilities, claims, causes of action and demands for personal injury, property damage, or any claim of whatever nature or kind, together with any resulting costs and legal fees, arising out of or caused by any act or omission or alleged act or omission, including a negligent or grossly negligent act or omission, of the Amarillo Chapter of TAME and TAME's agents, servants, or other employees, or occurring on or about the Amarillo Chapter of TAME or TAME's premises: this agreement to hold harmless specifically and expressly include liabilities, claims, causes of actions, and demands for personal injury, property damage, or any other claim of whatever nature or kind caused by or allegedly caused, in whole or in part, by the negligent or grossly negligent acts or omissions of the Amarillo Chapter of TAME and TAME Inc., or its agents, servants or other employees, without regard to amount. 

 TAME, Inc., is committed to protecting the privacy and safety of all children. There are times when we feel it is appropriate to recognize children and their work in a public forum. Examples of such recognition include publishing a team roster on our web page, exhibiting student art work on the web, displaying photographs of students participating in TAME events on the web or in printed material, and inviting local media to report on events.By signing this Permission Form you are giving TAME, Inc., permission to publish photographs of your child, in print and electronic media including publication on TAME’s internet web site, for any TAME, Inc.-related purposes. This permission is given with no promise or expectation of value in return.           Initials ____________

 In addition, in case of accident or sudden illness to my child, I authorize the officials of the Amarillo Chapter of TAME or TAME Inc., to take action deemed necessary to ensure my child's safety or well-being.  I understand that, in case of an emergency, someone will try to contact me or, if I cannot be reached, the other person listed below.

 AGREED TO AND SIGNED BY: ___________________________________________      

 Father/Mother/Legal Guardian (Circle one):      (Print) ______________________________________

Address:  ___________________________________ Telephone: ________________________________

 Person to Contact in Case of An Emergency, If Parent/Guardian Cannot be reached:

 Name:_________________________________________ Relationship: ___________________________

 Address: _________________________________________ Telephone: ___________________________

 Family Doctor: ____________________________________ Telephone: __________________________

 Please List Special Medical Needs or Instructions On the Back: