Form 11009 Sleepover at the National Archives Consent and Release

OMB Control No. 3095-0043
Expiration date: 12/XX/20XX

SLEEPOVER AT THE NATIONAL ARCHIVES CONSENT AND RELEASE
This form is submitted in order to be allowed by the National Archives and Records Administration (“NARA”) and
the National Archives Foundation (“the Foundation”) (NARA and the Foundation collectively referred to as “the
Host”) to participate in a Sleepover at the National Archives (“the Program”) under the following terms:
I understand that Host staff and volunteers shall lead all activities and that I/the minor agree to comply fully with
their instructions. I am aware that, as the parent, legal guardian or chaperone of the minor, that I am required to stay
with the minor at all times during the event.
I understand that photographs or videos of the minor and I may be taken by the Host during the Program. I
hereby grant the Host a perpetual, royalty-free license to use my/the minor’s image(s), name(s),
likeness(es), and voice for any purpose deemed appropriate by the Host, including, but not limited to,
exhibits, research, publications, educational, archival, and public relations purposes, as well as
informational programming and notices regarding the Program on the Host’s web site and social media.

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I understand that I will be responsible for any injury or damage I/the minor cause to the Host, including
damage to personal property. I understand and expressly assume the risk of any and all damage or injury,
including death, that may occur to me/the minor, or me/the minor’s property.

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I understand and acknowledge the minor’s participation in the Program and I hereby waive, on behalf of
myself/the minor, and our heirs, any and all claims or potential claims against the Host and the Host’s
employees, officers, directors, volunteers, principals, and agents, including claims for personal injury,
death, property damage, or other loss, arising directly or indirectly from my/the minor’s participation in the
Program, whether caused by negligence or otherwise.

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I hereby agree to indemnify and save and hold harmless the Host, its employees, officers, directors,
volunteers, principals, and agents from any loss, liability, claim, obligation, damage, or cost, which in any
way arise out of or for in connection with my participation in the Program. I hereby assume liability for any
loss or damage or any other liability arising from or related to my participation.

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I/the minor have read the rules of conduct set forth on archivesfoundation.org/sleepover/rules, and agree to
abide by these rules during the Program, as well as all applicable federal laws and regulations. The Host
reserves the right to ask you and the minor to leave should you fail to follow the Host’s instructions, rules, or
guidelines.

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I acknowledge that I have received, read, and understood and agreed to the above terms, and voluntarily
sign this Consent Form and Release; that no oral representations, statements or inducements apart from the
foregoing written agreement have been made; and that I am at least 18 years of age and have the legal
capacity to enter into this agreement.

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Minor’s Name (please print): ________________________________________ Age: ________________
Name: ________________________________________
Parent or Legal Guardian (please print)

Date: ________________

Parent or Legal Guardian’s Signature: _________________________________________ D.O.B:______________
Address: __________________________ Phone: _____________ Cell: ____________
City: _____________________________ State: ____________ Zip: _______________

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION

NA FORM 11009 (04-18)