Consent Statement
To whom it may concern:
Participation: I do hereby consent to participate as a volunteer chaperone and engage in activities sponsored by the California Legislative Black Caucus (CLBC) for the African American Leaders of Tomorrow (AALT) Conference taking place at California State University Dominquez Hills in Carson, California on July 20 through July 23, 2022.
Medical permission: I am not aware of any physical or medical condition that would interfere with my ability to participate as a chaperone or volunteer.
In the event I am injured or becomes ill, and neither I nor any individual identified as my emergency contact can be successfully contacted after a reasonable effort to do so, I, grant CLBC permission to seek medical attention for my child. As a result, I am providing my consent to the CLBC, and/or the adult in whose care my child has been entrusted, to arrange medical care for my child, which may include but is not limited to X-ray examinations, anesthetics, medical, surgical or dental diagnoses, treatment, and hospital care, to be provided under the general or special care, supervision, and/or advice of a physician or dentist licensed under California law, or provided by another licensed medical professional.
I, the undersigned, shall not under any circumstances hold CLBC or any affiliates involved in the Conference liable for any injuries I sustain by myself for any costs or expenses associated with any medical and dental services rendered. Should it be necessary for me to be returned home due to medical reasons or otherwise, I, the undersigned, shall assume all transportation costs.
Waiver: In consideration for being permitted to participate in the Conference, I, for myself, my child, or ward, my heirs, personal representatives or assigns, do hereby covenant not to sue and release, waive, and discharge CLBC, the California State Senate, and the State of California, its officers, employees, and agents from liability from any and all claims including the negligence of CLBC, the California State Senate, the State of California, its officers, employees, and agents, resulting in personal injury, accidents, or illnesses (including death), and property loss arising from, but not limited to, participation in the Conference.
Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD the State of California, the California State Senate, CLBC, its officers, employees, and agents, HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney’s fees brought as a result of my involvement in the Conference and to reimburse them for any such expenses incurred.
Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Code of Conduct: I agree to be courteous and respectful to my fellow Conference staff, volunteers, and participants. I will act in a professional manner and execute the duties directed by the CLBC to the best of my ability during the Conference. I will not be disruptive. I will not solicit nor promote the use of illegal substances, promote illegal activity, including underage drinking or discuss illegal activities with the intent to commit them. I agree to report any disruptive behavior that occurs during the conference. If I violate this Code of Conduct, I understand I may be excluded from the Conference and from future CLBC events.
I understand that I may be photographed during the course of attending the AALT Conference. I grant CLBC and its agents and affiliates full and unlimited permission to use my name, photograph or any other recording of participation in the AALT conference in any broadcast, telecast or other account of the AALT conference for publicity purposes, without compensation.
