UB: Summer Institute Permission/Release

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Gulf Coast State College's TRiO Department
Upward Bound Grant Project
Summer Institute Permission/Release Form

Instructions:

This form must be completed by a Parent/Guardian for an Upward Bound (UB) participant to:

Attend TRiO's 2026 Summer Institute at Gulf Coast State College from June 8 – July 17, 2026; &
Travel with UB to The University of North Florida, Flagler College, and Edward Waters University (i.e., Jacksonville & St. Augustine, FL) the week of July 13–17, 2026.

Please read this document carefully and email TRiO@GulfCoast.edu, call (850) 769-1551 x3397, or visit UB at Room 89 of GCSC's Student Union West building if you have any questions or concerns. UB Summer Institute seats are limited and spots fill fast, so submit this form by May 15, 2026 for priority consideration!

Note: Students/participants cannot complete this form on behalf of their parent(s)/guardian(s).

I. Student/Participant Information:

Student's first name:

Student's last name:

Student's date of birth:

Student's cell phone number:

II. Parent/Guardian Information:

What is your First Name?

What is your Last Name?

What is your Cell Phone number?

What is your Email Address?

III. Acknowledgments:

A) I acknowledge that I am the legal parent or guardian of the student/participant detailed above and grant permission for them to participate in UB's Summer Institute—including all travel and educational activities.

B) I understand that transportation may be provided by TRiO to and from various activities using chartered buses, GCSC-owned vehicles, or other approved vendors/providers. I acknowledge that participation in travel and related activities involves inherent risks—including but not limited to transportation-related incidents, weather conditions, and general travel risks. To the extent permitted by law, I voluntarily assume these risks on behalf of my student/participant.

C) In the event of an emergency, I authorize UB staff or their designees to seek, arrange, or facilitate emergency medical treatment for my student/participant if I cannot be reached in a timely manner. I understand that reasonable efforts will be made to contact me prior to such treatment. I acknowledge that I am financially responsible for any medical expenses incurred as a result of such treatment.

D) I agree to disclose any medical conditions, allergies, medications, or accessibility needs that may affect my student’s/participant's participation in this activity, and I understand that failure to disclose relevant information may limit UB’s ability to provide appropriate accommodations or respond effectively in an emergency.

E) I understand that my student/participant is expected to comply with all UB rules, institutional policies, and staff instructions at all times. I also acknowledge that serious misconduct may result in my student/participant being sent home at my (i.e., parent/guardian's) expense and/or disciplinary action consistent with UB's Participant Handbook.

F) To the fullest extent permitted by law, I agree to release and hold harmless Gulf Coast State College, TRiO, UB, its trustees, officers, employees, and agents from any claims arising out of my student’s participation in this activity, except to the extent caused by gross negligence or willful misconduct.

G) I acknowledge that UB has contracted with Tried & True Tutoring LLC (DBA: Tried & True Education) for the delivery of a "Film & Video Production" course and hereby:

Grant Tried & True Tutoring LLC, Gulf Coast State College, and each entity's representatives the irrevocable right and permission to record, use, reproduce, edit, and distribute video and/or audio recordings of my student/participant taken during the 2026 Summer Institute's "Film & Video Production" course;
Understand and permit that recordings taken during the 2026 Summer Institute's "Film & Video Production" course may be used for educational, promotional, and archival purposes, including but not limited to online courses, training materials, and marketing content, in any media format now known or later developed, without further notice or compensation;
Waive any right to inspect or approve of the finished product, or any use to which it may be applied, for recordings taken during the 2026 Summer Institute's "Film & Video Production" course; &
Release and discharge Tried & True Tutoring LLC, Gulf Coast State College, their employees, agents, and assigns from any claims, demands, or causes of action arising out of or related to the use of recordings taken during the 2026 Summer Institute's "Film & Video Production" course.

IV. Parent/Guardian Signature:

I acknowledge that by typing my full legal name below and submitting this form, I intend to sign and adopt this "Summer Institute Permission/Release" record electronically.

Full legal name (First, Middle Initial, & Last):

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