CENTER FOR BIOLOGICAL AND ENVIRONMENTAL NANOTECHNOLOGY
SUMMER INTERN PROGRAM
PARTICIPATION AGREEMENT AND
RELEASE OF
LIABILITY
I________________________, the
parent of ____________________, wish for my child to participate in the Center
for Biological and Environmental Nanotechnology Summer Intern Program under the
supervision of Dr. Mary E.R. McHale at the Rice University Department of Chemistry
(“Program”).
The dates of the internship
are from Monday, June 30, through Friday, July 11 2008. It is my responsibility to confirm the
schedule in advance with the Program’s organizers. During my child’s participation in the Program,
my child will participate in activities that include trips to water sources to
take samples for analysis in the laboratories at Rice University. My child may also participate in some
experiments and will be listening to lecture. I understand some of these activities may
involve walking to, or traveling by car or bus, to other locations.
My child is in sufficient physical and mental health to
participate in the Program and does not have any physical or mental conditions that
could prevent his/her participation in the Program. I understand that Rice will not provide any
insurance for my child in connection with his/her participation in the Program.
I understand that if my child requires medical
treatment while participating in the Program, an attempt will be made to notify
me. In the event that I cannot be
reached, I consent to such treatment for the child as may be deemed necessary
under the circumstances, including, but not limited to, x-ray examinations,
surgery and anesthesia.
If my child’s participation
in the Program is at any time deemed detrimental to the Program or its other
participants, as determined by the Program’s organizers in their sole
discretion, I understand that he/she may be expelled from the Program without
Rice or the organizers incurring any liability.
In return for my child’s participation in the Program, I release and
hold harmless Rice University, its students, trustees, employees, Dr. Mary E.
R. McHale, members of the Department of Chemistry and the Center for Biological
and Environmental Nanotechnology and all other representatives from any and all
claims, causes of action and liabilities for bodily injury or property damage
arising, directly or indirectly, in connection with my child’s participation in
the Program.
This
agreement constitutes the entire agreement, and takes the place of any prior
agreements or understandings regarding this Program. This agreement may not be changed, and it may
not be assigned or transferred. This agreement
shall be governed by the laws of the State of Texas. In the event any provision of this agreement
is held unenforceable by a court of competent jurisdiction, this will not
affect any other provision and this agreement shall be construed as if the
unenforceable provision had not been incorporated in this document.
Signature of Parents or Legal
Guardians:
Printed Name of Parents or
Guardians:
Parents’ Address:
Telephone:
Date:
Medical Insurance Carrier: