Virtual Shadow Program Registration Form

  = Required Information


Your registration will not be submitted if there is missing or incomplete information.

Family Information

Address Information

Contact Information

Desired Shadow Program date.

Participant Information

School Information

Consent to Participate and Waiver and Release

The undersigned parent or legal guardian (“I” or the “undersigned”) of the minor child identified below (my “Student”) do hereby give my consent for my Student to participate in the High School Shadow Program (the “Shadow Program”) being offered by The Center for Aquatic Sciences, Inc. (the “Center”).

I acknowledge that by signing this document I will be bound by the terms and conditions it contains. I also understand that if I choose to submit this document electronically, by placing my name on the document in the signature blank, I am providing my electronic signature. I agree that my electronic signature has the same binding effect as my written signature.

By signing this Consent to Participate and Waiver and Release, I hereby acknowledge and agree on behalf of myself and my Student as follows:

  1. I understand that the Shadow Program will be live and interactive in an online format. I agree that the Shadow Program sessions may be recorded so that Students who can’t attend a session may view the recording or Students can review the session again. I understand that these recordings may include audio and video interactions that may include my Student.
  2. I acknowledge and agree that by participating in the Shadow Program, my Student will see and hear and can elect to be seen and heard by others participating in the Shadow Program. I also acknowledge that anyone who is in proximity to my Student during the session will see and hear what my Student sees and hears and may also be seen and heard by the other Students attending the session.
  3. I hereby select the following provision as to use of likenesses of my Student:
I CONSENT to the taking of and use of photographs, video, voice recordings, electronic images, and likenesses of my Student
and anyone in proximity to my Student during the session and their use for promotional and programmatic purposes by the Center.
I acknowledge and agree that such materials shall be the sole property of the Center.
I DO NOT CONSENT to the taking of and use of photographs, video, electronic images, and likenesses of my Student and anyone in proximity to my Student during the session. I acknowledge and agree that I shall be responsible to ensure that the video function on my Student’s computer is disabled.
  1. I acknowledge and agree that any and all information, materials, and content that are presented in any format or medium by the Center during the Shadow Program are the sole and exclusive property of the Center and that I may not use them for any purpose without the prior written consent of the Center.
  2. All names, photographs, information, communications, and any other content that I, my Student or any member of my Student’s family post, submit to, or publish on an online social media account (e.g., Facebook, Instagram) that such person owns and then links to or otherwise associates with the Shadow Program is hereinafter defined as the “User Materials.” I hereby grant the Center an irrevocable, non-exclusive, royalty-free, fully-paid, transferable, sub-licensable, perpetual, and universe-wide license for the Center to host, store, reproduce, transmit, distribute, sell, resell, license, sublicense, market, modify, adapt, create derivative works, communicate, publish, syndicate, publicly perform, publicly display, archive, and otherwise use and exploit all or any part of such User Materials and any elements and derivatives thereof in any manner, medium, or form, whether now known or hereinafter devised, as the Center sees fit in its sole discretion.
  3. I acknowledge and agree that I am responsible for obtaining consents to the use of any content that I post, submit to, or publish on any social media account, including content that contains photographs or other images or likenesses of other Student from such Students’ parents or guardians and agree to indemnify and hold the Center harmless from any and all claims arising out of the posting of such content
  4. I acknowledge that protecting the privacy of children is of paramount importance. I understand that the Center will use reasonable safeguards including disabling personal chats, using waiting rooms to verify registered families’ access, and requesting that families only list first names and last initial of Students. By participating in the Shadow Program, I acknowledge and agree that I and my family are solely responsible for, and will exercise caution, discretion, common sense, and judgment during virtual meetings to protect the privacy of children.
  5. I acknowledge that the Center has a zero tolerance policy for bullying. I understand that, at the Center’s discretion, Students will receive an appropriate warning of inappropriate behavior and I may be informed and asked to discuss corrective solutions with my Student. I also acknowledge and agree that the Center has the right, at its discretion, to excuse my Student from the Shadow Program without a refund in the event my Student is in repetitive or egregious violation of this policy.
  6. In consideration of my Student being permitted to participate in the Shadow Program, and to the maximum extent permitted by law, I, for myself and for my Student and his or her family, hereby release, discharge, and hold harmless the Center and its officers, directors, employees, and agents from and against, and waive any and all claims for, any and all damages, liabilities, injuries, losses, costs, or expenses arising from or relating to my Student’s participation in the Shadow Program, the Center’s presentation of the Shadow Program and the programs of the Shadow Program, and any information or materials contained in the programs of the Shadow Program.
  7. I acknowledge receipt of handbooks and policies provided by the Center pertaining to the Shadow Program and agree to comply with all of the provisions applicable to parents and guardians and my Student.

Emergency Contact Information

Release Electronic Signature

10/7/2022 ]

Payment and Refund Acknowledgement

Payment is due in full upon reservation.
If you need to reschedule, please contact us at least 2 weeks prior to the program date.
Cancellations received less than 2 weeks in advance will receive a 50% refund.
You can pay your reservation online or make checks payable to “The Center for Aquatic Sciences”.

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