Consent Waiver Form 2017
I, as The Participant or Parent or Legal Guardian of The Participant grant permission for myself, The Participant or child, The Participant to participate in this teen nightclub event or any other teen events held at FroZEN75, 4427 East Sunset Road, Henderson, NV 89014
As The Participant or Parent and/or Legal Guardian, I remain legally responsible for any personal actions taken by The Participant.
I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend FROZN, LLC dba FroZEN75, its officers, directors, employees and agents, chaperones, or representatives associated with this and all other event held at this location, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate FROZN, LLC dba FroZEN75, its officers, directors, employees and agents, chaperones, or representatives associated with this and all other event held at this location, for reasonable attorney’s fees and expenses which they may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the FROZN, LLC dba FroZEN75.
FROZN, LLC dba FroZEN75, its officers, directors, employees and agents, chaperones, or representatives associated with this and all other event held at this location, is not responsible for any lost or stolen items during any and all activities at this location.
As The Participant or Parent and/or Legal Guardian, I grant FROZN, LLC dba FroZEN75, its officers, directors, employees and agents, chaperones, or representatives associated with this and all other event held at this location, the right to take and use The Participant's photograph or video footage of The Participant during any and all activities held at this location with or without my, The Participant or Parent and/or Legal Guardian name both individually and in conjunction with other persons or objects for any and all purposes including, but not limited to private or public presentation, advertising,publicity and promotions.
I authorize FROZN, LLC dba FroZEN75, its officers, directors, employees, and agents, to share information about The Participant with the City Of Henderson when necessary. I have read and fully understand the terms and requirement of this form. I execute the release voluntarily and with full knowledge of its significance and consequences.
Medical Matters: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport The Participant to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor, in the event of an emergency, if you are unable to reach me at the above numbers contact.
I have read this form and fully understand FROZN, LLC dba FroZEN75 rules and regulation, age requirements and procedures as discussed in detail on the companies website, www.frozen75.com and it's my responsibility to stay up to date on any changes that may or may not be made on the companies website after the signing of this form as long as I, as The Participant or Parent or Legal Guardian of The Participant continue to participate in any and all activities held at this location.
Signature of The Participant or Parent or Legal Guardian of The Participant complewting this form,
______________________________________________________. Date ___________________________
Parent or Legal Guardian
1st Teen's Full Name
Parent or Legal Guardian's Address
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Parent or Legal Guardian's (Teen) Email
Parent or Legal Guardian's Phone Number
The Participant's (Teen) DOB
Attach a File: Attach a picture ID of the Parent or Legal Guardian who is submitting this form.
Attach a File: Attach a picture of The Participant (Teen) who's attending the event or events.
Type the characters from the image below.
Do Not Fill This Out