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2021 HBCU Tour Registration

  1. Gender*

  2. If Yes, what year?

  3. Photo Release:

  4. City, State, Zip

  5. I consent to this Photo Release Form. I grant Waukegan Township, its volunteers, employees, agents, representatives, and licensees permission to copy, edit, publish and otherwise use my name, image and likeness, with or without my name. This includes marketing purposes or for any other lawful purpose, in any publication and in any medium, including, by way of example and not limitation, posting a photo of me from the tour/meeting on a social media, web site, (collectively, “Reproduction”) without compensation. I assign to Waukegan Township all rights, title and interest in and to all such Reproductions as well as the unencumbered right to exercise such rights in all media and by any means now known or hereafter created, throughout the world, in perpetuity. I hereby hold harmless and release and forever discharge Waukegan Township and its volunteers, employees, agents, representatives, and licensees, from all claims, demands, and causes of action which I or the undersigned or any respective heirs, executors, administrators or assigns have or may have resulting by reason of this Photo Release Form.

  6. Electronic Signature*

    I HAVE READ THIS PHOTO RELEASE FORM BEFORE SIGNING BELOW AND I FULLY UNDERSTAND THE CONTENTS, MEANING, AND IMPACT OF THIS PHOTO RELEASE FORM:

  7. Waukegan Township Permission Slip & Waiver

  8. Electronic Signature*

    I acknowledge that I am the parent or legal guardian of the student referenced above and give permission for my child to attend the 2021 Artis Yancey HBCU Tour presented by Waukegan Township & Partners. I understand that in the event my child does not exhibit the expected behavior, I will be contacted and depending on the severity of his/her infractions while online. I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) releasing the Township from all liability on my and the Participant’s behalf, (b) waiving my and the Participants’ right to sue the Township, (c) and assuming all risks of Participant’s participation in this Activity. I understand that I am responsible for the obligations and acts of the Participant as described in this document. I agree to be bound by the terms of this document.

  9. This form MUST be completed and accompany completed application packet. ALL information should be read thoroughly, completed and signed by parent or responsible party. 

  10. EMERGENCY CONTACT INFORMATION (In addition to the Medical Consent Information form):

  11. Electronic Signature*

    Signature of parent or legal guardian

  12. Leave This Blank:

  13. This field is not part of the form submission.