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PARENTAL CONSENT FORM

Dear Parent or Guardian:

In order for your child to participate in an activity hosted by Pacific Links Foundation, we need your consent and involvement in helping your child have a productive and safe experience.

Please carefully read and sign this parental consent form. If you have any questions or would like further information, please contact us via email at visitors@pacificlinks.org.

 

There are 8 questions in this survey.
GENERAL INFORMATION
(This question is mandatory)
CHILD
(This question is mandatory)
PARENT/GUARDIAN
(This question is mandatory)
PHYSICIAN
(This question is mandatory)
PERSON TO BE NOTIFIED IN CASE OF AN EMERGENCY

In connection with and consideration of my child's (named above) participation in Pacific Links Foundation’s activities, I, on behalf of my child and myself, my heir(s), personal representative(s) and assign(s), hereby represent and agree as follows:

  • I understand that my child will be a volunteer/participant in activities hosted by Pacific Links Foundation, and I hereby give permission for him/her to serve in that capacity with Pacific Links Foundation.
  • I understand that my child will be provided with the orientation and training necessary, and as needed, for the safe and responsible performance of the duties assigned.  He/she will be expected to meet all the requirements of the position, including regular attendance and adherence to Pacific Links Foundation’s policies and procedures.
  • Should my child require emergency medical treatment, first aid, or transportation to a hospital or medical facility as a result of illness or injury associated with my child's participation in Pacific Links Foundation’s activities, I consent to any such treatment, first aid and/or transportation that may be provided to my child, and understand that  I will be responsible for costs associated with any of the foregoing and that Pacific Links Foundation will not be responsible for any costs associated with any of the foregoing.
  • I understand that as a volunteer/participant in Pacific Links Foundation’s activities, my child may participate in physical activity. I represent and warrant that my child is in good physical condition, and has no physical, health-related or other problems which would preclude or restrict his/her participation in this program or related activities or otherwise render his/her participation dangerous or harmful to him/her or others, and that he/she is allowed to participate in physical activity, which includes but is not limited to basketball, soccer, martial arts, running, and dancing.
  • I understand that as a participant in Pacific Links Foundation’s activities, my child may be provided food and it is the responsibility of my child to ask about ingredients in all food he/she chooses to ingest, and I have discussed this responsibility with him/her.
  • I authorize Pacific Links Foundation’s to publish or release to the media any pictures of my child during his/her time as a volunteer/participant for promotional or recognition purposes.
(This question is mandatory)
  • I, the undersigned, certify that I am the parent or legal guardian of the child (named above) and that I have the right to make decisions for my child that affect his/her well being. I recognize and acknowledge that physical injury, accident, illness, death, loss of personal property, or other contingencies may befall my child as a participant in Pacific Links Foundation’s activities. I understand that my child is not in any way required to participate in the activities, and despite these risks, I want him/her to participate in the preceding. In light of the preceding and with sufficient knowledge of my child's physical and other conditions and limitations, if any, I voluntarily assume all responsibility and risk of loss, damage, illness and/or injury to person or property which my child may, in any way, sustain in connection with his/her participation in the program and related activities. I understand it is my responsibility to carry health insurance for my child.
  • In consideration of my child's participation in the program and related activities, I agree to release Pacific Links Foundation and its board members, officers, employees, donors, guests, associates, and volunteers from any and all liabilities, damages, losses and/or causes of action (collectively, "Claims") that I or my child may suffer or have, including without limitation, to our persons or property or both, which arise out of, are related to or in connection with, or occur during, my child's participation in or attendance at the program and related activities except to the extent any such Claims are caused by the gross negligence or willful misconduct of the employees of Pacific Links Foundation.
  • I further agree to indemnify and hold harmless Pacific Links Foundation and its board members, officers, employees, donors, guests, associates, and volunteers from any and all Claims arising out of, related to, or in connection with the program or related activities that are caused by my or my child's negligent or intentionally tortuous acts and/or omissions.
  • I agree that this agreement shall be governed by the laws of Vietnam and the United States without giving effect to any choice or conflict of law principles of any jurisdiction, and if any portion of this agreement is held invalid, the remainder of the agreement shall continue in full force and effect.

I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER AND THAT I HAVE READ, FULLY UNDERSTAND AND AGREE TO THE TERMS OF THIS AGREEMENT, AND I SIGN IT VOLUNTARILY WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Parent/Guardian's Signature

(This question is mandatory)
Parent/Guardian's Full Name (please print)
(This question is mandatory)
Date
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