I, the undersigned, hereby give permission for my child to participate in all activities (unless otherwise specified in writing) and assume all risks and hazards incidental to the program. I agree to hold harmless Camp Curiosity, Sprout House LLC, Leadership Learning Academy, its staff, and appointed assistants for any and all liabilities, claims, or demands arising out of any injury to my child or loss or damage to my child’s possessions while participating in the program. I, also understand and agree to abide by any restrictions placed on my participation in on site activities. I hereby give permission to Sprout House LLC to seek emergency medical treatment for my child in the event it becomes necessary. I understand that Sprout House LLC will contact me and my emergency contact prior to treatment. If unable to reach either, I authorize a health care provider to offer any treatment deemed necessary and I accept full financial responsibility for this care. This completed form may be photocopied. Consent & License. For my participation in activities to be conducted by Sprout House LLC, and collaborating third parties, I consent, to the making, reproduction, editing, broadcasting or rebroadcasting of: video film or footage of me and/or my child • sound track recordings of me, photo reproductions of me any narrative account of my experience. My consent includes a perpetual license to Sprout House LLC for the use of the above materials for publication, display, exhibition in promotions, advertising, and education uses. Use includes reproductions in any form and media currently existing or later conceived, adaptations and/or revisions, throughout the world in perpetuity. I understand and agree there may be no additional compensation for this license, and I will not make any claim for payment of any kind from Sprout House, LLC or collaborating third parties. I may, or may not be, identified in such licensed uses; however, my name will not be used to endorse any particular products or services. By typing or signing my name below, I acknowledge that I have reviewed and agree to the above terms.