Consent to Participate. If the Player is a minor, I, as the parent or guardian of the Player, or if the Player is not a minor, I, as the Player, hereby give my permission for the Player to participate in any and all programs, activities, and events sponsored, sanctioned, or offered by FCF, including without limitation, training sessions, practices, league play, tournaments, scrimmages, skills festivals, soccer schools, day camps, overnight camps, overseas trips, and fund-raising events (the “Programs”), whenever and wherever held, including indoors and outdoors, and on any surface type, whether grass, artificial turf, carpet, concrete, asphalt, wood, or tile.
Consent to Participate. This Volunteer Waiver and Release of All Claims for Minors executed as of the day and year first written. Information From the Parent Having Legal Custody or Legal Guardian (“Guardian”) I, , am the parent, whether natural or adoptive, or court appointed legal guardian of the minor child identified as the Volunteer of this Waiver and Release. I have the authority and do hereby give full permission for the Volunteer to take part in the activities (as defined above). My minor child is qualified and physically capable of accomplishing the work and activities for which I have consented they volunteer, and that they will perform them as directed by a properly authorized supervisor and also agree to comply with all City rules and regulations. In the event of an injury, I authorize the City to seek treatment and to take other action should a medical emergency arise and waive and release my right for damages. Parent/Guardian Signature Date First Name Last Name Address City/State/Zip Phone (Home/Work/Cell) E-mail Primary Emergency Contact Emergency Contact Phone Number Secondary Emergency Contact Emergency Contact Phone Number Name of Minor (“Volunteer”) Minor’s Signature Date First Name Last Name Birth Date Phone (Cell) Email The Volunteer has the following tools, skills, certifications that will help with this project: Approval By City Signature (Village of Indian Hill Representative) Date First Name Last Name
Consent to Participate. By signing this document, you are attesting that you have received, read, and fully understand the information above, and that you are consenting to participation in Spiritual Healing with Xxxx Xxxxx. Signature Date
Consent to Participate. Parties may consent to mediation or to arbitration. Parties may also consent both to mediation and, in the event that mediation fails to result in an agreed resolution, to arbitration. The undersigned parties do hereby agree to submit to mediation and/or arbitration of their controversy concerning the legal fees charged by the attorney named herein. The parties authorize a duly appointed panel of the Virginia State Bar Circuit Committee on the Resolution of Fee Disputes to act as Mediator(s) and/or Arbitrator(s) and to proceed to hear this matter pursuant to the Fee Dispute Resolution Program Rules & Guidelines. Mediators will seek impartially to facilitate communication between the parties and, without deciding the issues or imposing a solution, try to enable the parties to reach a mutually agreeable resolution. Arbitrators shall be vested with all the powers and shall assume all the duties granted and imposed upon arbitrators by Virginia law, including the power to determine the manner in which the arbitration proceeding shall be conducted. It is expressly agreed, however, that each party shall be entitled to be heard and shall have the right to be represented by an attorney at any mediation session or arbitration hearing. It is also agreed that the mediators and arbitrators shall serve without compensation and shall be governed by the Fee Dispute Resolution Program Rules & Guidelines. The parties understand and agree that a mediated agreement is enforceable as a contract under Virginia law. The parties further understand and agree that judgment may be entered on an arbitration award in any court of competent jurisdiction in the Commonwealth of Virginia and, therefore, any award rendered shall be binding. Consent to arbitrate is irrevocable, which means that, once this form is signed either party is entitled to go forward with a determination of the merits of the dispute and with court entry of an award, even if the other party later chooses not to participate in the proceedings.
Consent to Participate. If the Player is a minor, I, as the parent or guardian of the Player, or if the Player is not a minor, I, as the Player, hereby give my permission for the Player to participate in any and all programs, activities, and events sponsored, sanctioned, or offered by FCF, including without limitation, training sessions, practices, league play, tournaments, specialized training (e.g., fitness, agility, balance, speed and strength (FABSS), goalkeeping, goal-scoring/strikers), scrimmages, skills festivals, soccer schools, day camps, overnight camps, overseas trips, and fund-raising events (the “Programs”), whenever and wherever held, including indoors and outdoors, and on any surface type, whether grass, artificial turf, carpet, concrete, asphalt, wood, or tile.
Consent to Participate. I consent to participation in the Program and acknowledge that I fully understand my participation may involve risk, including losses which may result not only from my own actions, inactions or negligence, but also from the actions, inactions or negligence of others, the conditions of the facilities, equipment or areas where the Program is being conducted, and/or the rules of the Program. I freely choose to travel, study, volunteer, or intern at the organization or location indicated above, for the purposes of study, developing personal, business and or social service skills and or personal experience as may be applicable and freely accept all the risks associated with the Program I expressly agree that I am not an employee of Rensselaer or Rensselaer@Hartford, and have no employee rights or benefits including, without limitation, any workers’ compensation benefits.
Consent to Participate. As a condition of participation, the Participant shall consent to the terms and conditions of this Agreement, as may be amended from time to time.
Consent to Participate. I consent to my child/xxxx participating in the program or activities described below (hereinafter referred to as “the Activity”).
Consent to Participate. Your signature below shows that you have read and understood the information in this document, and that you agree to volunteer as a research participant for this study. You will be offered a copy of this form. Clicking the box below confirms that you have read and understood the information in this document and you agree to volunteer as a research participant for this study. Consent ⎦ Yes, I have read and understood the information in this document and would like to volunteer as a research participant in the study. ⎦ No, I do not wish to participate. [If YES is selected to the consent item above, participant will be routed to a separate survey, where identifying data will be kept separate the consent form, so that if names were ever discovered, there would be no linkage to study content.] Please enter your electronic signature in the line below: Please select one box below to indicate how you would prefer to receive a copy of this consent form. ⎦ I would prefer to receive an electronic copy by email. My email address is ⎦ I would prefer to receive a paper copy by mail. My home address is BROWN UNIVERSITY CONSENT FOR RESEARCH PARTICIPATION ATTC Condition: Center Providers and Leadership Consent Implementing Contingency Management in Opioid Treatment Centers across New England: A Hybrid Type 3 Trial Version Date: December 10, 2018 KEY INFORMATION: You are invited to take part in a research study conducted by Brown University, in partnership with RTI International and the New England Addiction Technology Transfer Center. Your participation is voluntary. • PURPOSE: To compare two different ways to train providers and leaders at opioid treatment centers in contingency management (CM). • PROCEDURES: Center providers and leaders will be asked to complete 1) a survey about their opinions of the organization’s support for CM implementation, their attitudes towards CM, as well as some basic demographic questions, at two time points, 2) a full-day CM workshop, and 3) monthly coaching calls. Additionally, center providers will be asked to record and send “practice” CM sessions and actual CM sessions (with patients who have provided consent to participate) for performance feedback. They will be asked to completed CM self-report forms. Center leaders will be asked to work with a CM trainer to develop a CM compliance definition and benchmark and to complete Medical Record Data Extraction forms. • TIME INVOLVED: The study will take about 30 hours for center providers an...
Consent to Participate. Your signature below shows that you have read and understood the information in this document, and that you agree to volunteer as a research participant for this study. You will be offered a copy of this form. Clicking the box below confirms that you have read and understood the information in this document and you agree to volunteer as a research participant for this study. Consent ⎦ Yes, I have read and understood the information in this document and would like to volunteer as a research participant in the study. ⎦ No, I do not wish to participate. [If YES is selected to the consent item above, participant will be routed to a separate survey, where identifying data will be kept separate the consent form, so that if names were ever discovered, there would be no linkage to study content.] Please enter your electronic signature in the line below: Please select one box below to indicate how you would prefer to receive a copy of this consent form. ⎦ I would prefer to receive an electronic copy by email. My email address is ⎦ I would prefer to receive a paper copy by mail. My home address is
