Shape Your Community: Urban Planning Workshop

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Academic Information

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Event Questions

Pizza will be provided for lunch. If you have food allergies we should know about, please explain below and we will do our best to accommodate.

Yes, I have food allergies

No, I do not have any food allergies

Food Allergies

Would you like information about other summer workshops?

Yes

No

How did you hear about the program?

Acknowledgement of Risk

I, the undersigned, desire that the applicant listed above, a minor of whom I am the parent having legal custody and/or the legal guardian of the estate and the person of the minor, be permitted to participate in the Urban Planning Workshop (the “Workshop”), which will be held at Ball State University Architecture Building on June 19, 2027, which will include a bus tour of different examples of urban planning throughout Muncie (downtown Muncie, Craddock wetlands, etc.); or at Ball State University CAP Indy Center on June 12, 2027. I hereby authorize my child to fully participate in the Workshop, with the understanding that such participation shall include, but not be limited to, use of equipment, use of facilities, instruction, and bus tour/transportation involved with the Workshop. I understand that the University encourages me to have a physical examination or health screening of my minor child and to obtain adequate health and accident insurance prior to my child’s participation in the Workshop. I hereby certify based upon my own knowledge and such consultation with a physician (if I have consulted one) that my child has no health problems that would interfere with my child’s participation in the Workshop. I hereby certify that I understand and appreciate that participation in the Workshop may result in bodily injury or personal injury (whether physical, emotional, and/or psychiatric or any combination thereof) to my child, including but not limited to bruises, scrapes, disease, strains, bone fractures, concussion, partial and/or total paralysis, heat stroke, heart attack, stroke, and death and may result in loss, damage or destruction of my or my child’s personal property. I further understand and appreciate that such illness, injury, loss, or damage may be caused by mechanical issues, transportation accidents, the negligence of the University or any of its employees, agents, contractors, or volunteers. The participation of my child in the Workshop is purely voluntary, and I elect for my child to participate in the Workshop in spite of the risks. I am voluntarily assuming the risks and I understand that the University will not be responsible for any property loss or damage, or for any physical ailment or injury, including death, sustained by my child while participating in the Workshop.

I have read and agree with the Acknowledgement of Risk

Yes

Release of All Claims

In consideration of my child’s participation in the Workshop, I, the undersigned parent or legal guardian, agree to release and on behalf of myself, my child, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE the University, its Board of Trustees, officers, employees, and agents from any liability, actions, causes of action, claims, or demands of any nature whatsoever, including, but not limited to, a claim of negligence on the part of the University, its Board of Trustees, officers, employees, contractors, agents, or volunteers, which I or my child may have as a result of any personal injury, property damage, permanent disability, or death my child may suffer in connection with my child’s participation in the Workshop.

I have read and agree with the Release of Claims

Yes

Indemnification of the University

In consideration of my child’s participation in the Workshop, I, the undersigned parent or legal guardian, further agree to DEFEND, INDEMNIFY, AND HOLD HARMLESS the University, its trustees, officers, agents, and employees from any and all causes of action, claims, demands, liability, losses, or costs of any nature whatsoever, including, but not limited to, attorney fees, court costs, and investigatory costs, arising out of or in any way relating to my child’s participation in the Workshop.

I have read and agree with the Indemnification of the University

Yes

Medical Authorization

I understand and agree that neither the University nor any of its trustees, officers, employees, agents or volunteers accept any responsibility for providing medical care services for my child and that the cost of any medical care services that my child may need remain my responsibility. In the event of a medical emergency for my child, I request that the individual named immediately below be contacted, and I agree that the officers, employee, or agents of the University are hereby authorized to consent to emergency medical treatment for my child on my behalf. I understand and agree that all costs of any such treatment are my responsibility and not that of the University or any of its officers, employees, agents, or volunteers. I, for myself, my child, my heirs, representatives, executors, administrators, and assigns, hereby waive, release, discharge, and hold harmless the University, its Board of Trustees, officers, employees, agents, and volunteers from any liability, actions, causes of action, claims, or demands of any nature whatsoever, either in law or in equity, including based on the alleged negligence of any of them, in connection with any decision of any of the University’s officers, employees, agents, contractors, or volunteers to obtain emergency medical treatment for my child.

I have read and agree with the Medical Authorization

Yes

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Governing Law and Venue

This Release constitutes the sole and entire agreement made between the parties and supersedes all prior negotiations, written and oral, conversations, correspondence, representations, agreements, proposals, and other communications regarding the subject matter hereof. Any amendment(s) to this Release shall not be valid unless made in writing and signed by both parties. Should any portion of this Release be found invalid or unenforceable, then to the extent that such portion is invalid or unenforceable, it shall not affect the validity or enforceability of any other portion of this Release. This Release shall be construed, and legal relations between the parties hereto shall be determined, in accordance with the laws of the State of Indiana applicable to contracts solely executed and wholly to be performed within the State of Indiana without giving effect to the principles of conflicts of laws. Any dispute as to any matter in this Release shall be brought in the state or federal courts of Indiana, and venue shall be in the state courts of Delaware County, Indiana or in the federal district court for the Southern District of Indiana, Indianapolis Division.

I have read and agree with the Governing Law and Venue

Yes

Agreement to the Terms of this Release

I certify that I am at least 18 years old and have read and understand the terms of this Release. I understand that by signing this Release I am relinquishing substantial legal rights, including the possibility of recovery for injury, whether the injury results from the inherent risks of the Workshop or the ordinary negligence of the University, its Board of Trustees, officers, employees, agents, contractors, or volunteers. I am signing this Release, after having carefully read the same, of my own free will, and by doing so, fully intend to release the University, its Board of Trustees, officers, employees, agents, and volunteers from liability or loss due to the inherent risks of the Program or the negligence of the University, its Board of Trustees, officers, employees, agents, contractors, or volunteers.

I have read and agree with the Agreement to the Terms of this Release

Yes

Parent/Guardian Signature and Date

Family Physician

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CONSENT AND RELEASE

I, the undersigned, irrevocably grant to Ball State University (“Ball State”) the right to use my child’s appearance in photographs or videotape for any purpose it deems proper. I understand that these photographs or videotapes may be used in Ball State publications, newsletters, news releases, and other printed materials, as well as in publicity materials on television and the Internet. I understand that the photographs or videotape of my child may be edited. I understand that my child’s name will not be used with the photographs or videotapes unless I give express permission and at the editorial discretion of the university. I understand that my child will not be given credit for his/her appearance in the photographs or videotape. I expressly release Ball State, its agents, trustees, officers, employees, licensees, and assigns from and against any and all claims that my child or I have or may have for invasion of privacy, defamation, or any other cause of action arising out of or relating to my child’s appearance in the photographs or videotape created by Ball State.

Parent/Guardian Signature and Date

Name of Child

Consent to Publish Child's Name