HMS MEDscienceLAB Consent Form

I give consent for the student listed below to participate in the Harvard Medical School MEDscienceLAB program for the 2024-2025 school year including weekly field trips to Harvard Medical Schools as well as other affiliated medical institutions in the Longwood area. I understand that I may be asked to sign additional forms required by specific sites as a condition  to  my student  being  permitted  to access these sites with the class. I also understand that as part of the program, my student will be asked to participate in a quick online survey both before and after the program to assess his/her interest in science, this program, and their career  aspirations. 

I hereby authorize President and Fellows of Harvard College, acting through Harvard Medical School and anyone Harvard may designate, to photograph, film and otherwise make video or audio recordings of the student (collectively, the “Images and Recordings”) in connection with his/her participation in activities at Harvard during the time in which he/she is enrolled as a student.

I hereby agree that Harvard will have the irrevocable, worldwide right to make, copy, edit, publish, distribute, show, broadcast, display and otherwise use and make available the Images and Recordings and any works that may be derived from them, by any means and in any media now existing or hereafter invented for any educational, research or Harvard-related purpose, including  but not limited to the promotion of the Harvard Medical School and other Harvard programs, and to authorize others to do the same. I understand and agree that such use of the Images and Recordings may include the use of my student’s first name and other non-confidential biographical information, such as program or year. I acknowledge that Harvard may choose not to use the Images and Recordings at this time, but may do so at its own discretion at a later date.

I hereby release Harvard and its officers, agents, employees and members of it governing boards from any and all claims which I may have at any time for invasion of privacy, defamation or other injury to reputation, violation of rights of publicity, or any other claim of any kind arising out of the use of the Images and Recordings.  

I understand and agree that I will not receive any royalties or other payment in connection with the Images and Recordings or for granting this release. I have read this release and fully understand its contents. This release is signed as a document under seal governed by the laws of the Commonwealth of Massachusetts. I give consent for quoted statements given by my student, audio, video, electronic images, or photographs to be used for purposes of news stories or other public media and research analysis with possible identification by full name. I give consent for follow up contact with myself and my student using student and parent/guardian contact information for the purpose of learning how students are progressing with their academics and future careers. 

I further hereby, on behalf of myself, the student, and anyone claiming through myself or the student do FOREVER RELEASE the President and Fellows of Harvard College, it’s trustees, officers, members of its governing boards, employees, volunteers, students, agents, and assigns ( collectively, “Harvard”) , and MASCO from any cause of actions, claims, or demands of any nature whatsoever, including but not limited to a claim of negligence which I, the student, or anyone claiming through myself or the student, may now or in the future have against Harvard on account of personal injury, bodily injury, property damage, death or accident of any kind, arising out of or in any way related to the student’s participation in the program, howsoever the injury is caused.

ACKNOWLEDGEMENT OF RISK AND RELEASE 

Non-Harvard Personnel Under the Age of 18 Using Harvard Research 

Laboratory and Instructional Facilities 

THIS IS A RELEASE OF LEGAL RIGHTS – PLEASE READ AND UNDERSTAND BEFORE SIGNING

I, the undersigned, parent or guardian of a minor, do hereby accept and agree to the following terms and conditions in consideration for my child’s use of Harvard University’s research and instructional laboratory facilities. 

1) Access to Facilities. The research facilities are being made available to my child as an educational opportunity. My child is not a student, employee or affiliate of Harvard University, and my child has not been provided with a Harvard University Identification card or keys to the research facilities.

2) Health and Safety Risks. I understand and have explained to my child the following information:Harvard University research laboratories may contain hazardous substances and equipment. My child must take every precaution necessary to protect his or her health and safety, and the health and safety of others. My child must acquaint him or herself with and conduct his or her activities in accordance with all safety rules and safe operational procedures. If my child is not familiar with or does not knowhow to handle safely a substance or piece of equipment, he or she will seek assistance from qualifiedHarvard University personnel. My child recognizes that he or she may be subjected to potential risks, illnesses and injuries. My child and I have made our own investigation of these risks, understand these risks and assume them knowingly and willingly.

3) No Medical Coverage. I understand that if my child is injured as a result of his or her activities atHarvard University, he or she is not covered by Harvard University insurance of any kind. It will be my responsibility to pay for emergency room care, doctors’ services, hospitalization, and any other related costs, medical or non-medical. My child will not be eligible to participate in HarvardUniversity’s health, disability or life insurance programs. Furthermore, he or she is not eligible for workers’ compensation in the event of injury.

4) Appropriate Conduct. My child agrees to observe all applicable governmental, University and departmental policies, rules and regulations that pertain to his or her conduct on campus and in the research facilities. I agree that Harvard University officials may require my child to leave the research facilities if they believe that my child has violated a policy, rule or regulation or if they believe that my child’s conduct is inappropriate.

5) Confidentiality. My child and I agree not to disclose or to use, directly or indirectly, any proprietary or confidential research, data, trade secrets or other similar information of which we may become aware of as a result of my child’s activities in Harvard University’s research facilities.

6) ASSUMPTION OF RISK AND RELEASE OF CLAIMS. Knowing the risks described above, I agree, on behalf of my family, heirs and personal representative(s), to assume all the risks and responsibilities on account of, or in any way arising out of, directly or indirectly, my child’s use of and access to Harvard University’s research laboratories. To the maximum extent permitted by law, I release, acquit, discharge, and covenant to hold harmless and agree to indemnify Harvard University, its officers, directors, faculty, staff, representatives, volunteers, employees and agents, from and against any present or future actions, causes of action, demands, judgments, claim, loss or liability for injury to person or property, real or personal, which my child may suffer, or for which my child maybe liable to any other person, during his or her use of and access to the research laboratories, resulting from any cause including but not limited to negligence (except for fraud, willful misconduct or violation of law) by Harvard University, its directors, officers, faculty, staff, representatives, volunteers, employees or agents.

I have carefully read this ACKNOWLEDGEMENT OF RISK AND RELEASE and I execute it voluntarily and with full knowledge of its significance. This agreement shall be governed by the laws of the Commonwealth of Massachusetts (excluding its conflict of laws principles), which shall be the forum for any lawsuits filed under or incident to this agreement. I agree that in the event that any clause or provision of this agreement shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause of provision shall not otherwise affect the remaining provisions of this agreement which shall continue to be enforceable.

Parent and student: Signing below will serve as your legal signatures and represents your agreement for yourself, your spouse (if applicable), and your child to each of the preceding paragraphs.