(please print from your computer and submit it to the CosFest Desk when you check in.)
Minor's Name :____________________________________________________________
Date of birth: ________________________________________________________________
Guardian's Name: _____________________________________
Guardian's Relation to Applicant: ______________________________________________________
Pacific Media Expo (PMX) cannot assume responsibility for the safety and welfare of minors while engaged in the Cosplay Festival (CosFest) beyond making reasonable provision for welcoming you as a chaperone for the minor indicated.
Your signature below indicates that you understand that your child must abide by all rules, regulations and staff instructions while participating in the contest, and that PMX staff cannot prevent injuries because they cannot always control the conditions present or be present at all times. Your signature below constitutes and is evidence of your agreement to (1) accept general liability for the participation of your child in CosFest and (2) indemnify and hold harmless Pacific Media Expo, Pacific Media Association (PMA), its employees and agents, either jointly or severally, from and against any and all claims, damages, causes of action or injuries, including reasonable attorneys’ fees and costs expended in defense thereof, incurred or resulting from your child’s participation in CosFest.
Applicant's or Guardian's Signature:______________________________ Date:_______
Emergency Contact Address:
Emergency Contact Phone #: