Family Festival
Kansas City Missouri
June 13th & 14th, 2009
2009 Parental Consent Form
For all participants under the age of 19 must have a parental consent form signed.
Your signature on the parental consent form, gives consent for your child under the age of 19 to participate in
the Forty Acres & A Mule, Inc. Juneteenth Family Festival Contest and Events on June 13-14, 2009. You
understand that the activities involved with the Tournament program contain an element of hazard or risk. You
recognize the inherent danger involved and take full responsibility for my or my child’s actions and physical
condition. In consideration of your own child’s participation in the Contests, you hereby, for yourself and/or your
child, your heirs, executors and administrators, waive and release any and all rights and claims for damages you
or your child may have against Forty Acres & A Mule, Inc., Event Sponsors or Charities and their volunteers,
employees, representatives and successors for any injuries or any loss or damage to personal property suffered
by me and/or my child while engaged in Juneteenth Family Festival activities. You agree to indemnify and hold
Forty Acres & A Mule, Inc., Event Sponsors or Charities and any of their volunteers, agents, officials or
employees free and harmless from any liability, loss, cost or expense including attorney fees, which may result
from my participation and/or my child’s participation in Juneteenth Family Festival activities. You agree that you
are fully responsible for payment of all costs resulting from the rendering of medical aid and ambulance services
to you and/or your child as a participant in the Juneteenth Family Festival activities and you authorize that all
necessary first aid steps may be taken as prescribed by qualified personnel. You grant full permission to use any
photographs, videotapes, recording or any other record of the Juneteenth Family Festival program for any
purpose without any reimbursement of any kind due to you or your child. By signing the parental consent form,
you acknowledge that you have read, understand and agree to abide by this information and the rules and
regulations of the Tournament or Contest

Please present the form at sign-in at the table prior to the competition.  Any team member on the roster under
the age of 19 will not be allowed to participate in competition without the parent/ guardian signature.  The coach
of the team, must attest that the signatures on the form are authentic for the each child listed. You understand
that you take full responsibility and liability for the child’s medical costs if the child is injured while competing in
Juneteenth Family Festival contest or event.