PARENT/GUARDIAN INFORMED CONSENT FOR RESEARCH

Helping WIN (Women's Intersport Network of Kansas City) Provide a Winning Environment for Girls in Their Summer Sport Camps

KEY INFORMATION

• This project is gathering information about the children’s experiences at the camp.
• Your child’s participation in this research project is completely voluntary and will take about 10 minutes (total).
• Your child is being invited to complete a brief survey on the first and last day of camp.
• Participating in this study brings no risks.
• Results from the study can help Camp WIN administrators make the camp better, and results can be used to seek funding to provide more opportunities for girls to participate in physical activity programs.
• If you or your child choose for her not to participate in the study, she will just remain with her camp leader during those 10 minutes that others are completing surveys.

INTRODUCTION

The Department of Educational Psychology at the University of Kansas supports the practice of protection for human subjects participating in research. The following information is provided for you to decide whether you wish your child to participate in the present study. You may refuse to sign this form and not allow your child to participate in this study. You should be aware that even if you agree to allow your child to participate, you are free to withdraw at any time. If you do withdraw your child from this study, it will not affect your relationship with this unit, the services it may provide to you, or the University of Kansas.

PURPOSE OF THE STUDY

The purpose of this study is to gain feedback from campers to obtain their perceptions about their camp experience. In particular, the survey items have children indicate the extent that the environment created at Camp WIN was positive, caring, and focused on each child’s effort and improvement.

PROCEDURES

Your child will be invited to complete a brief survey on the first day of camp (upon arriving) and again on the last day of camp. Research leaders will assist with the completion of the surveys by reading the questions aloud for the girls.

RISKS

There are no risks for participating in the study.

BENEFITS

The results help Camp WIN administrators consider how they can make the camp better. Also, they can use the results to help them seek funding for continued and additional programs.

PAYMENT TO PARTICIPANTS

Campers receive no payment for completing the surveys.

PARTICIPANT CONFIDENTIALITY

Your child's name will not be associated in any publication or presentation with the information collected about your child or with the research findings from this study. Instead, the researcher(s) will use a study number or a pseudonym rather than your child's name. Your child’s identifiable information will not be shared unless (a) it is required by law or university policy, or (b) you give written permission. Permission granted to use your child’s response information remains in effect indefinitely. By agreeing to this form, you give permission for the use of your child's information, excluding your child's name, for purposes of this study at any time in the future.

PRIVATE INFORMATION (DATA) AND/OR BIOSPECIMENS – FUTURE RESEARCH USE

Your child’s identifiable information will not be used or distributed for future research studies even if your identifiable information is removed.

REFUSAL TO SIGN CONSENT AND AUTHORIZATION

Parents who do not want their child to complete the surveys can contact the WIN for KC at info@winforkc.org.

You are not required to agree to this Consent and Authorization form and you may refuse to do so without affecting your right to any services you or your child are receiving or may receive from the University of Kansas or to participate in any programs or events of the University of Kansas. However, if you refuse to agree, your child cannot participate in this study.

CANCELLING THIS CONSENT, AUTHORIZATION, AND QUESTIONS ABOUT PARTICIPATION

You may withdraw your consent to allow participation of your child in this study at any time. You also have the right to cancel your permission to use and disclose further information collected about your child, in writing, at any time, by sending your written request to: Mary Fry via email mfry@ku.edu.

If you cancel permission to use your child's information, the researchers will stop collecting additional information about your child. However, the research team may use and disclose information that was gathered before they received your cancellation, as described above. 

By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to this release and waiver including the refund policy. 

REFUND POLICY: Registrations fees (not including processing charges) will be refunded until April 1. From April 1 to May 1, participates can receive partial refunds (half of the camp registration fee, not including processing charges. NO REFUNDS will be granted after May 1. 

In consideration of you accepting this entry, I, the participant, intending to be legally bound do hereby waive and forever release any and all rights and claims for damages or injuries that I may have against the Event Director, RunSignup.com, and all of their agents assisting with the event, sponsors and their representatives, volunteers and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees.

I know that playing sports are potentially a hazardous activity. I should not enter and run unless I am medically able to do so and properly trained. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of weather, traffic, and course conditions, and waive any and all claims which I might have based on any of those and other risks typically found in playing sports. I acknowledge all such risks are known and understood by me. I agree to abide by all decisions of the camp director relative to my ability to safely participate at camp. I certify as a material condition to my being permitted to enter this camp that I am physically fit and sufficiently trained for the completion of this camp and that a licensed Medical Doctor has verified my physical condition.

In the event of an illness, injury or medical emergency arising during the event I hereby authorize and give my consent to the Event Director to secure from any accredited hospital, clinic and/ or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medications, treatment and hospitalization.

Further, I grant permission to all the foregoing to use my name, voice and images of myself in any photographs, motion pictures, results, publications or any other print, videographic or electronic recording of this camp for legitimate purposes.

This event follows the standard running industry policy: All entry fees are non-refundable. We reserve the right to postpone or cancel the event due to circumstances beyond our control such as a natural disaster or emergency or as required to protect the safety of participants and staff. No refunds will be issued under these circumstances. We reserve the right to change the details of the event without prior notice. I understand that my entry fee is nonrefundable and bib numbers are non transferable.

Participant or Parent/Guardian of Participant: I understand and acknowledge that I am legally agreeing to the statements in the following paragraphs of this Waiver Agreement by affixing my signature below; and I further understand and acknowledge that my statements are being relied upon by camp sponsors, organizers, administrators, staff, contractors, volunteers and other parties defined below as the "Released Parties." 

1. I acknowledge that this camp which includes multi-sport events (hereinafter called the "Camp") tests a person's physical and mental limits and carries with it the potential for death, serious injury, illness and property damage. I acknowledge and agree that it is my responsibility to determine whether my camper/captain/junior captain (hereinafter referred to as participant) is sufficiently fit and healthy enough to safely participate in this camp, and I attest and certify that she is or will be sufficiently fit to participate in any camp event which I elect to enter. She has no physical or medical condition which would endanger herself or others if she participates in any camp event, or that would interfere with her ability to safely participate in any camp event. I accept responsibility for my conduct in connection with the Camp.  

2. On behalf of myself, my executors, administrators, heirs, next of kin, successors and assigns, and anyone else who might sue on my camper’s behalf, I HEREBY WAIVE, RELEASE, and FOREVER DISCHARGE, WIN for KC, and affiliates, Notre Dame de Sion High School, Pembroke Hill School, which includes its staff and facilities, the Greater Kansas City Sports Commission and the Greater Kansas City Sports Foundation, all Camp sponsors, Camp producers, Camp staff, administrators, officials, contractors, vendors, and organizers, volunteers, all other persons or entities involved with the Camp, states, cities, towns, and other governmental bodies and locations in which the Camp or portions of the Camp takes place, and the officers, directors, employees, agents, insurers, other participants and representatives of all of the above (collectively, the "Released Parties"), from any and all claims, causes of action, damages, losses (economic and non-economic), and liabilities of every kind (collectively "Claims"), for death, personal injury, illness, or property damage, which may arise out of, result from, or relate to my camper’s participation, or her traveling to or from the Camp, including but not limited to any Claims for theft, damage to any equipment, negligence, partial or permanent disability, Claims relating to the provision of first aid, medical care, medical treatment, or medical decisions (at a Camp site or elsewhere), and any Claims for medical or hospital expenses. I hereby allow WIN for KC, its staff, qualified representatives, administrators and officials the right and ability to administer necessary daily medication to my participant as directed by me during camp registration and/or through doctors’ instructions presented on site and/or ability to administer any necessary basic first aid attention as needed, including but not limited to, band-aids, epi-pens, Tylenol, etc. I acknowledge that I have advised WIN for KC staff in writing of any medication, or needs allergies. 

The organization has adopted the following procedures in caring for the participant if she becomes sick or injured while attending camp. (All numbers utilized below will be provided by participant's parent/guardian through paperwork.) (1) The camp will call home and/or cell phones, if there is no answer, 2) the camp will call the emergency contacts, 3) If none of the above answer, the camp will call an ambulance, if necessary, to transport the child to a local medical facility, 4) Based on the judgment of the attending physician, the child may be admitted to a local medical facility, 5) The camp will continue to call the parents, guardian, and emergency contacts until one is reached. If I cannot be reached and the camp authorities have followed the above procedures, I agree to assume all expenses for moving and medically treating the camper. In the event I cannot be reached in an emergency, I hereby give permission to the attending physician to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for my child as named above. In case of an emergency, I give permission to the appropriate summer camp personnel to have my child properly transported to a medical facility for care immediately, and other staff will follow the procedures of contacting the parents.

3. I acknowledge and ASSUME ALL OF THE RISKS and aspects of the Camp. I understand that my participant will be participating in the Camp at my own risk, that I am responsible for the risk of participation in the camp, and that I am waiving and releasing my legal rights to sue for any injury or damages arising out of or resulting from my camper’s/captain's participation in an Event. I further understand that any injury or damages incurred may be the result of negligence, omission or carelessness by the Released Parties.

4. I FURTHER COVENANT and AGREE NOT TO SUE any of the Released Parties for any of the Claims that I have waived, released, or discharged herein. I AGREE TO INDEMNIFY and HOLD HARMLESS the Released Parties from any and all expenses incurred, Claims made, or liabilities assessed against them, including but not limited to attorneys' fees and litigation expenses, arising out of or resulting from, directly or indirectly, in whole or in part, my breach or failure to abide by any part of this Waiver Agreement, my camper’s breach or failure to abide by camp rules, and my camper’s actions or inactions which cause injury or damage to any other person.  

5. I FURTHER GRANT the Greater Kansas City Sports Commission, The Greater Kansas City Sports Foundation and WIN for KC (collectively "WIN for KC"), and Camp for Kids, the right to use my camper’s image in all forms and media for WIN for KC's marketing, promotional or related materials (the "Materials") throughout the world and in perpetuity. I WAIVE any rights to future compensation to which I might otherwise have been entitled for such use. 

6. The parent or legal guardian who signs this Waiver Agreement on behalf of a minor, incapacitated and/or mentally challenged person (hereinafter "Said Person"), hereby acknowledges that he or she has the legal capacity and authority to act on behalf of Said Person to legally bind Said Person to the Waiver Agreement. The parent or legal guardian who signs the Waiver Agreement agrees to indemnify and hold harmless the Released Parties for any expenses incurred, Claims made, or liabilities assessed against them, as a result of any insufficiency of legal capacity or authority to act on behalf of Said Person in the execution of the Waiver Agreement.

7. In order to protect our participants and ensure a safe event, each individual participating in this event must be officially registered under her own name with accurate personal information. Failure to do so will void the registration and prohibit participation. Registration entries cannot be transferred to another person under any circumstances or used by registrant in subsequent years. Registration fees are non-refundable in all cases regardless of inability to participate or event cancellation. The Camp director reserves the right to cancel the event(s) because of weather, natural disaster or other unforeseen circumstances which pose a significant danger to the participants.

8. If any provision of this Waiver Agreement shall be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Waiver Agreement and shall not affect the validity and enforceability of any remaining provisions. 
Processing Fee: Each registration will be charged a Processing fee at the time of checkout, which is non-refundable. You will be able to see the total fee on the following summary page prior to the processing of the transaction. This fee is based on the negotiated rate with the event host. 

BY INDICATING YOUR ACCEPTANCE OF THIS AGREEMENT AND WAIVER, YOU ARE AFFIRMING THAT YOU HAVE READ AND UNDERSTAND THIS ENTIRE AGREEMENT AND WAIVER AND FULLY UNDERSTAND ITS TERMS. YOU UNDERSTAND THAT YOU ARE GIVING UP SUBSTANTIAL RIGHTS, INCLUDING THE RIGHT TO SUE. YOU ACKNOWLEDGE THAT YOU ARE SIGNING THE AGREEMENT AND WAIVER FREELY AND VOLUNTARILY, AND INTEND BY YOUR ACCEPTANCE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

I/We understand that the Greater Kansas City Sports Commission and the Greater Kansas City Sports Foundation carries no insurance of any kind to cover medical expenses which may incur from athletic concussion in sports. By typing my name below I, the parent/guardian, acknowledge receipt of the Children's Mercy Hospitals & Clinics Concussion Care Card and certify that I have read and understand the document. Students cannot practice or compete in any activities until the waiver has been signed.

If you are registering a child under the age of 18 you represent and warrant that you are the parent or legal guardian of that party and have the legal authority to enter into this agreement on their behalf and by proceeding with this Event registration, you agree that the terms of this Agreement and Waiver shall apply equally to all Registered Parties. By registering a child under 13, you agree and consent to the collection of that child's information which you provide for the purposes of registration. 

I sign this waiver in acceptance on behalf of the minor participating in this event.