I certify the information provided above is correct to the best of my knowledge.                    

PARTICIPANT & LIABILITY WAIVER

*REQUIRED INFORMATION

PHOTO RELEASE WAIVER

I certify by signing that I am agreeing to all the information enclosed on this form below and above.

As the student, parent and/or legal guardian of student listed above, I/we authorize and agree to participate in any and all academic year and summer component activities (classes, tutorials, advisement/counseling sessions, workshops, field trips, work study internships, meetings, cultural trips, research studies -CPPs, advisory board, student club, parent meetings, community service or volunteer hours) sponsored and/or conducted by the Los Angeles Southwest College - Educational Talent Search (ETS) program . 

 

Photography – Release - Minor Child

I/we also give permission to LASC and ETS at LASC the right to photograph me or my child at events and for emergency purposes.  I hereby authorize LASC/ETS, through its employees, representatives, to take video and still photographs and use my likeness or that of the child in LASC and/or LACCD publications including but not limited to class schedules, handbooks, brochures, flyers, websites, advertisements and any promotional materials on an unlimited basis.  I acknowledge that I am not entitled to any form of payment for the photograph/video or for any future publications of the photograph.  I also agree to waive any and all future claims, causes of actions and/or use of my likeness or that of the child.  My signature on this document acknowledges that I have read and understand the provisions and agree to abide by the terms.  I am at least 18 years of age or a legally emancipated minor.  In addition, I/we provide permission to transport between his/her school, the college campus and the scheduled events for participants. 

 

I/we do hereby grant permission to the ETS program at LASC and its authorized representatives, to furnish first aid as I or my child may require. As well as to seek medical attention through the nearest medical facilities when students are on field trips, on campus or other authorized activities.  This permission is conditional upon the understanding that in the event of serious illness or the need for hospitalization and/or major surgery, ETS staff members will use all reasonable efforts to contact (a parent/guardian) me.  Failure in such efforts should not prevent ETS from providing emergency assistance to my child.

 

STUDENT SCHOOL RECORDS RELEASE AUTHORIZATION

I/we authorize ETS at Los Angeles Southwest College to obtain documents in reference to and consistent with my (son/daughter) educational career.  Such documents may include: national clearinghouse, report card, school transcript, test scores, exams, class schedule and school lunch program eligibility.   

 

I/we authorize ETS to obtain documents related to my (student) college, financial aid, or an (son/daughter) application related to my educational career or receipt of student financial aid (federal, state, or other) and college admissions.  I/we understand the information on this document will be used to monitor my (child’s) academic performance, assist in providing academic advisement. Determine program eligibility and help with their college planning.

I am aware of the Family Educational Rights and Privacy Act (FERPA) e 20 USC 1232g, is the federal law providing the review and disclosure of student educational records.  The (ETS) TRIO programs at LASC will not permit access to or release of personally identifiable information contained in the students educational records to any party without the written consent of the student (guardian) except as authorized (FERPA) to share on students behalf for academic success.