P A R E N T A L C O N S E N T F O R M

Student’s Name: ______________________________________________ (Please Print)

Parent/Guardian’s Name: _______________________________________ (Please Print)

I, the parent/guardian of the above named child, permit my child to participate in all the activities of the Clark Atlanta University Mobile Robotics Workshop. I understand that Clark Atlanta University may use and publish my child's school, city, photograph, digital image, work, or other material submitted, in various promotional, in-service, or other presentations. To this end, I waive any and all claims that I may have on behalf of my above named child against Clark Atlanta University and release Clark Atlanta University its successors or agents from any and all claims and demands.

____________________________________ ________________

^{(Parent/Guardian Signature) (Date)}