MTN CHAMPS PARENTAL CONSENT FORM
This form is to be completed by a parent (or legal guardian) for every participating athlete registered for MTN Champs (the
Event), organized by Making of Champions Limited (MoC). The main purpose of this form is to verify you are aware of the
registration of your child in the event – by their School if they are in the Cadet (U14) or Youth (U17) Categories, OR by their
Team or individually for the Juniors (U20) – and that you consent to your child’s participation based on the terms herein.
The information collected in this form is for record purposes only.
YOUR NAME:_________________________________________
YOUR ADDRESS:________________________________________________________________________
FULL NAME OF YOUR CHILD/PARTICIPANT:_____________________________________
DATE OF BIRTH OF YOUR CHILD/PARTICIPANT:__________________________________
NAME OF SCHOOL OF YOUR CHILD/PARTICIPANT:_____________________________________________
CITY & DATE OF MTN CHAMPS EVENT FOR CHILD/PARTICIPANT: __________________________________
YOUR RELATIONSHIP WITH CHILD/PARTICIPANT:________________________________
IF NOT PARENT, PROVIDE DETAILS OF YOUR LEGAL GUARDIANSHIP:_______________________________
YOUR ID DOCUMENT NO. (Passport, Permanent Voters Card, Driver’s License, National ID Card):___________________
YOUR PHONE NUMBER(S):__________________________________________________
YOUR EMAIL ADDRESS (IF ANY):_____________________________________________
I hereby confirm/agree the following:
1. That I am the parent/legal guardian of a participant and all the information provided above is true and correct. I
understand that any false information provided could disqualify my child/ward from competing or lead to an erasure
of his/her records if discovered after the competition.
2. That I understand that MoC will obtain personal information for identification and registration. Pictures and video
footage will be recorded at the Event and some of the participants will be interviewed. MoC and other sponsors of
the Event will use such material collected for purposes including but not limited to reporting the event and
marketing, and such may be displayed or recorded in media now now known or hereafter developed, throughout
the World. I consent to this and grant MoC and its sponsors a right to use this footage in any medium and in
perpetuity. This includes the use of this material in the international media for the purpose of advertisement,
promotion, publication, business, marketing, public relations, and media coverage. I cede any right to review or
approve the use of any of such material.
3. I authorize MoC and the medical personnel provided for the Event to provide any First Aid care, or any other
treatment deemed necessary for my child/ward in an injury.
4. I indemnify MoC, its sponsors, directors, authorized agents, employees, and representatives from any liability
resulting from my negligent conduct or omission during participation of my child in the event. I also release and
discharge MoC, its sponsors, officers, directors, employees, representatives, and agents, from and against any and
all liability, losses, claims, demands and causes of action for personal injury and other damage that may result
from my child/ward’s participation at the Event.
5. That my child/ward is healthy, his/her participation at the Event is voluntary, and he/she is well prepared for it.
6. That I will advise my child/ward to abide by the rules of participation at the Event, and to note that no alcohol or
substance use/misuse will be permitted while participating at the Event. Should my child/ward be found
participating in such activity, MoC and its agents have the right (in their absolute discretion) and my permission to
expel my child/ward from the Event.
7. That myself and my child/ward shall be responsible for the safekeeping of my personal property/belongings as well
as those of my child/ward at the event.
8. That I am the parent/legal guardian of the above-named child/ward and consent to the foregoing on his/her behalf.
______________________________________ ___________________________
YOUR SIGNATURE DATE
