NYC High School Pop-Up Registration Form

- ACKNOWLEDGMENTS AND AGREEMENTS OF STUDENT AND PARENT/GUARDIAN
- I agree and consent to the following for my minor child:
  
  • My minor child will be attending the _STEM from Dance Pop-Up__(“Activity”) conducted from __Saturday, March 28, 2026
  from 12-4pm_(”Day/Time”)__, at _(”Location”)__Barnard College__. I am fully aware of the risks and hazards involved in my minor child participating in the Activity, including those related to COVID-19. For this Activity, participants will be on the Barnard College campus interacting with members of the college community. I am aware that some attendees may not be vaccinated. I am aware that it is possible for my minor child to be exposed to and/or contract COVID-19 in connection with my
  attendance at and participation in the Activity, including my minor child's transportation to and from the location of the Activity – even if my minor child is fully vaccinated. I will ensure my minor child adheres to the College’s policies and follows local, state and federal requirements and guidelines as they relate to COVID-19.
  
  • I am responsible for my minor child's transportation to and from the Activity.
  
  • I assume responsibility for all risk or theft, loss or damage of my minor child's personal property which occurs at any time arising out of my minor child's participation in the Activity.
  
  • To the extent permitted by law, and in consideration for my minor child being allowed to participate in the Activity, I hereby save, hold harmless, discharge and release Barnard College, its current and former Trustees, officers, agents, employees, and representatives from all claims, demands and causes of action (including medical costs and expenses) which I (as the parent or legal guardian of the minor child), my heirs, representatives, executors, administrators or any other persons acting on my
  behalf or on behalf of my estate. I agree to indemnify and hold harmless, waive and covenant not to sue Barnard College, its officers, Trustees, agents, employees and representatives from liability for the personal injury of any person(s) or damage to
  property that may result from my minor child’s negligent or intentional act or omission while participating in the Activity.
  
  • By participating in the Activity, I consent for my minor child to be photographed or otherwise recorded by the College or its designee for news, promotional purposes, or other College uses, including but not limited to publication of such recordings on
  its website and social media.
  
  • Medical Insurance: I acknowledge and accept that participating in the Activity may expose my minor child to hazards and risks and that Barnard College cannot control these risks. I acknowledge there may be physically strenuous activities and certify
  that my minor child is fit and capable of such participation. I am responsible for understanding my minor child’s own physical limitations and operating within them at all times and I assume full responsibility for any risks, injuries or damage known or
  unknown which my minor child may incur as a result of participating in the Activity.
  
  • I understand that Barnard College is not responsible for any medical expenses associated with any personal injury my child may sustain and understand that Barnard College does not provide medical insurance for me and my minor child. I certify that my minor child is covered by adequate insurance to cover any personal injury which they may sustain while participating in the Activity at Barnard College. I hereby authorize the faculty and staff of Barnard College to act for me according to their best judgment in any emergency requiring medical attention for my minor child. I authorize and give consent for Barnard College to administer general first aid for any minor injuries or illnesses experienced by my minor child.
  
  • I have read the above waiver and release of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
  
  • I understand that this Agreement is to be as broad and inclusive as is permitted by the laws of the State of New York, and that if any portion of this Agreement is held invalid, the remaining terms shall continue in full force and effect.
  
  Acepto y consiento lo siguiente para mi hijo menor de edad:
  
  • Mi hijo menor de edad asistirá a _____ STEM from Dance Pop-Up__ (“La actividad”), _ Saturday, March 28, 2026 from
  12-4pm_ (“dia e hora”) __at Barnard College (“ubicación”)___. Soy plenamente consciente de los riesgos y peligros que conlleva la participación de mi hijo menor de edad en la actividad, incluidos los relacionados con COVID-19. Para esta
  actividad, los participantes estarán en el campus de Barnard College interactuando con miembros de la comunidad universitaria. Soy consciente de que algunos asistentes pueden no estar vacunados. Soy consciente de que es posible que
  mi hijo menor esté expuesto y/o contraiga COVID-19 en relación con mi asistencia y participación en la actividad, incluido el transporte de mi hijo menor hacia y desde el lugar de la actividad. - aunque mi hijo menor de edad esté totalmente vacunado. Me aseguraré de que mi hijo menor de edad se adhiera a las políticas de la universidad y siga los requisitos y directrices locales, estatales y federales en lo que respecta a COVID-19.
  
  • Soy responsable del transporte de mi hijo menor de edad hacia y desde la actividad.
  
  • Asumo la responsabilidad de todo riesgo de robo, pérdida o daño de los bienes personales de mi hijo menor que se produzca en cualquier momento como consecuencia de la participación de mi hijo menor en la actividad.
  
  • En la medida en que lo permita la ley, y en consideración a que se permita a mi hijo menor de edad participar en la actividad, por el presente salvo, eximo de responsabilidad, libero y exonero a Barnard College, a sus fideicomisarios
  actuales y anteriores, funcionarios, agentes, empleados y representantes de todas las reclamaciones, demandas y causas de acción (incluidos los costos y gastos médicos) que yo (como padre o tutor legal del hijo menor de edad), mis herederos,
  representantes, albaceas, administradores o cualquier otra persona que actúe en mi nombre o en nombre de mi patrimonio. Acepto indemnizar y eximir de responsabilidad, renunciar y comprometerme a no demandar a Barnard College, sus
  directivos, fideicomisarios, agentes, empleados y representantes de la responsabilidad por lesiones personales de cualquier
  persona o personas o daños a la propiedad que puedan resultar de un acto u omisión negligente o intencionado de mi hijo menor de edad durante su participación en la Actividad. Al participar en la actividad, doy mi consentimiento para que mi hijo
  menor de edad a ser fotografiado o grabado por la universidad o su designado para noticias, fines promocionales, u otros usos de la universidad, incluyendo pero no limitado a la publicación de dichas grabaciones en su sitio web y medios de
  comunicación social.
  
  • Seguro médico: Reconozco y acepto que la participación en la actividad puede exponer a mi hijo menor de edad a peligros y riesgos y que Barnard College no puede controlar estos riesgos. Reconozco que puede haber actividades
  físicamente extenuantes y certifico que mi hijo menor de edad es apto y capaz de dicha participación. Soy responsable
  de comprender las limitaciones físicas de mi hijo menor y de actuar dentro de ellas en todo momento, y asumo plena responsabilidad por cualquier riesgo, lesión o daño conocido o desconocido que mi hijo menor pueda sufrir como resultado de su participación en la actividad.
  
  • Entiendo que Barnard College no es responsable de ningún gasto médico asociado con cualquier lesión personal que mi hijo menor pueda sufrir y entiendo que Barnard College no proporciona seguro médico para mí y mi hijo menor. Certifico
  que mi hijo menor de edad está cubierto por un seguro adecuado para cubrir cualquier lesión personal que pueda sufrir durante su participación en la actividad en Barnard College. Por la presente autorizo al profesorado y al personal de
  Barnard College a actuar en mi nombre según su mejor criterio en cualquier emergencia que requiera atención médica para mi hijo menor de edad. Autorizo y doy mi consentimiento para que Barnard College administre primeros auxilios generales
  para cualquier lesión o enfermedad leve que sufra mi hijo menor de edad.
  
  • He leído la anterior renuncia y exención de responsabilidad y comprendo plenamente su contenido. Acepto voluntariamente los términos y condiciones expuestos anteriormente.
  
  • Entiendo que este Acuerdo debe ser tan amplio e inclusivo como lo permitan las leyes del Estado de Nueva York, y que si alguna parte de este acuerdo se considera inválida, los términos restantes continuarán en pleno vigor y efecto.
- Parent Full Name*
- Today's date*
  
  MonthDayYear
  Date

Informed Consent and Liability Waiver Release for Participation in the Office for Community Engagement and Inclusion On-Campus Activity
I agree and consent to the following for my minor child:

My minor child will be attending the STEM From Dance High School Pop Up (“Activity”) conducted on Saturday, March 28th from 12:00pm - 4:30pm, at 3009 Broadway, NY NY 10027. I am fully aware of the risks and hazards involved in participating in the Activity, including those related to COVID-19. For this Activity, participants will be on the Barnard College campus interacting with members of the college community. I am aware that some attendees may not be vaccinated. I am aware that it is possible for me to be exposed to and/or contract COVID-19 in connection with my attendance at and participation in the Activity, including my transportation to and from the location of the Activity even if I am fully vaccinated.

I am responsible for my minor child's transportation to and from the Activity.

I assume full responsibility for any risks, injuries or damage of my minor child known or unknown which they might incur as a result of participating in the Activity.

I am responsible for understanding their own physical limitations and operating within them at all times.

To the extent permitted by law, and in consideration for being allowed to participate in the activity, I hereby save, hold harmless, discharge and release Barnard College, its current and former trustees, officers, agents, employees and representatives from any and all liability, claims, causes of actions, damages or demands of any kind and nature whatsoever that may arise from or in connection with my minor child's participation in any activities related to the Activity, whether caused by the
negligence or carelessness of Barnard College or its representatives.

It is my express intent that this Informed Consent and Liability Waiver shall forever bind the members of my family and my estate, heirs, administrators, personal representatives and assigns.

I further agree to save and hold harmless, indemnify and defend, and release Barnard College, its current and former trustees, officers, agents, employees and representatives from any claim by the aforementioned parties arising out of my participation in the Activity.

By allowing my minor child to participate in the Activity as an attendee, I consent for them to be photographed or otherwise recorded by the College or its designee for news, promotional purposes, or other College uses, including but not limited to publication of such recordings on its website and social media.

Medical Coverage: Insofar as the participant has a medical condition, it is the responsibility of said participant to have all necessary medications during the activity and to administer the prescribed dosage. The student can alert the organizational advisor of a medical condition as appropriate. Responsibility for medication remains with the student. Barnard College is not responsible for administering medical services to students or covering medical expenses for any injuries sustained during the participant's time at the College.

I have read the above waiver and release of liability and fully understand its contents.

I voluntarily agree to the terms and conditions stated above.

I understand that this Agreement is to be as broad and inclusive as is permitted by the laws of the State of New York, and that if any portion of this Agreement is held invalid, the remaining terms shall continue in full force and effect.
Parent Full Name:

First NameLast Name
Date

MonthDayYear
Date
Signature

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COMPLETE IF STUDENT IS AN ADULT OVER 18:
I acknowledge that I have carefully read this document, waiver, and release, and understand the information therein. My signature on this form shall constitute an informed and knowing waiver as required by law. I agree to each of the terms and acknowledgments above, and sign this document on behalf of myself, so that I may participate in the program described above.
Student Name

First NameLast Name
Date

MonthDayYear
Date
Student Signature*

Clear
Should be Empty:

NYC High School Pop-Up Registration Form

ACKNOWLEDGMENTS AND AGREEMENTS OF STUDENT AND PARENT/GUARDIAN

Informed Consent and Liability Waiver Release for Participation in the Office for Community Engagement and Inclusion On-Campus Activity

COMPLETE IF STUDENT IS AN ADULT OVER 18: