TN Boys State Consent & Accommodations Form

This form should be completed by the parent or guardian of the delegate.

The form is due by Friday, May 13, 2022.

Delegate's Name: * First Last
Delegate's Email Address: *
EARLY DEPARTURE

Minor participants will NOT be released to anyone other than the individuals listed below (not applicable to participants 18 years of age or over).
In case of early departure, my child may be released to the custody of the following people:
PERMISSION TO RESIDE IN TN TECH HOUSING (IF APPLICABLE)

I give permission for the participant to reside in Tennessee Tech Housing for the duration of the Program.
Signature of parent or guardian in the box below: *

Clear
PHOTO/ VIDEO CONSENT
Intending to be legally bound, I do hereby irrevocably consent to and authorize Tennessee Technological University, its officers, employees, and agents, (the “University”) and Tennessee American Legion Boys State (TNALBS) to use existing photographs, photograph, videotape, record, publish, re-publish, broadcast, rebroadcast, adapt, exhibit, perform, reproduce, edit, modify, make derivative works, distribute, display or otherwise use or reuse my name, image/likeness or voice in any media or technology now known or hereafter developed in connection with any product or service or promotional or informational campaign undertaken by the University or TNALBS in all markets as long as there is no intent to use the image, voice and/or likeness in a disparaging manner. University and TNALBS may exercise any of these rights themselves or through any successors, transferees, licensees, distributors, or other parties, commercial or non-profit.
Signature of parent or guardian in the box below: *

Clear
ACCOMMODATIONS
Does the participant have any food allergies or require a special diet? *

Does the participant have any food allergies or require a special diet? The participant DOES NOT have a special food request. The participant DOES have a special food request (please enter below):
Does the participant require any other types of accommodations (audio, visual, etc.)? *

Does the participant require any other types of accommodations (audio, visual, etc.)? The participant DOES NOT require other accomodations. The participant DOES require other accommodations (please enter below):

TN Boys State Consent & Accommodations Form

TN Boys State Consent & Accommodations Form

EARLY DEPARTURE

PERMISSION TO RESIDE IN TN TECH HOUSING (IF APPLICABLE)

ACCOMMODATIONS