Release and Consent Agreement

(“Student”) wishes to participate in various learning activities sponsored and conducted by The Academy of 21st Century Learning (“Academy”), both at its place of business in the Nut Tree Shopping Center in Vacaville, CA and at certain other locations, including individual and group tutoring and educational enrichment activities and programs (“Activities”). The undersigned parent or legal guardian of the Student desires that the Student participate in the Activities. In consideration of The Academy’s willingness to allow the Student to participate in the Activities, and as an inducement to The Academy to make the Activities available to the Student, the undersigned parent or legal guardian agrees as follows:

1. The undersigned releases from liability and holds harmless The Academy and its employees, agents, members and officers for any injury to the Student’s person or damage to his or her property, and such released persons, and each of them, shall have no responsibility for any medical expenses resulting from any injury incurred by the Student during, or as a result of, participation in the Activities. The undersigned understands that The Academy makes no representation as to the condition or safety of the land, structures, or surrounding properties that may be involved in the Activities, whether or not owned, leased or operated by The Academy.

2. The undersigned hereby grants to The Academy, its members, employees, and agents, the right and permission to publish, reproduce, distribute and/or otherwise use the undersigned’s name or the name of the Student and any and all still photos or moving photographic images or sound recordings of the undersigned or the Student in whole or in part and/or made in conjunction with similar performances made by other individuals (“Performance”), together with any statement or endorsement (“Testimonial”) made by the undersigned or the Student. The Performance and/or the Testimonial may be used in such manner, for such purposes and with such frequency as The Academy shall determine in its sole discretion relating to the promotion and marketing of the Activities, without any monetary or other compensation to the undersigned or the Student. The Performance and the Testimonial are the sole property of The Academy.

3. The undersigned acknowledges that except in connection with Activities described above, the employees and agents of The Academy are not authorized to transport Students or family members to and/or from The Academy for school, tutoring, or for any other purpose.

The undersigned states that he/she is the parent or legal guardian of the Student. The undersigned has read and understand the terms of this Release and Consent Agreement and such terms constitute the full and complete agreement of the undersigned and The Academy and supersedes all previous statements or agreements, either oral or written.

( "Student ") *
( "Student ")
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