Hackathon Authorization Form- County of Marin


Marin County Hackathon 2017
Terms of Participation & Parental Authorization

In order to participate in Hack4Health event (the "Event") on April 1, 2017, you must complete the following Terms of Participation form, and any minor under the age of 18 must have his or her parent or legal guardian complete this form.

Using the print icon on the right side of the page, display a printable version of this form and make a hard copy using your browser's print function, fill it in, and bring it with you to the event.

General Items

  1. The registration fee is non-refundable, even if you later are unable to participate in the event.
  2. All participants are strictly prohibited from engaging in any illegal activity during the Event. Participants are prohibited from attempting to access, modify, or damage any protected/secured network or other computer systems without authorization. Any individual that engages in illegal activity will be disqualified from participation and may be subject to criminal and/or civil liability.
  3. During the course of the Event, staff or volunteers may take photos or videos of the Event and its participants. By signing these Terms of Participation I grant to the County of Marin ("County") and its representatives the right to use my (or my minor child's) name, likeness, image, voice, and/or appearance as may be embodied in any recordings taken by or made on behalf of the County. I agree that the County has ownership of and may use such material without restriction and without my prior inspection or approval. Such uses include but are not limited to social media postings, announcements, news releases, websites, and promotional or informational materials in any medium. I acknowledge that I will not receive any compensation for the use of such images, recordings, or likenesses.
  4. I agree that if any portion of this form is held invalid, the remainder will continue in full legal force and effect.


  1. During the course of the Event, participants may have the chance to receive door prizes and/or a cash prize for the winning ideas generated during the Event, as determined solely by the Event Panel Judges.
  2. Door Prizes. Door prizes will be given out to some participants during the course of the Event. Participants must be present in order to receive items being given away as door prizes.
  3. Cash Prizes. Cash prizes for ideas generated during the Event will be awarded based on the winning ideas created. Decisions about the winning ideas will be made by a panel of judges, and all decisions of the judging panel are final and are not appealable. The prize amounts listed in the event materials, including the event website, are based on then-current pledges of donations, and no prize amounts are guaranteed at any level until final prize awards are given via check (which may occur after the Event). Participants must make a presentation regarding their final idea on the day of the Event to the judging panel in order to qualify to receive one of the prizes for designing app/software.
  4. Each winner must provide the Company with valid identification and a valid taxpayer identification number or social security number before any prize will be awarded. In order to receive any cash prizes, each qualifying participant must complete additional tax-related paperwork (I.R.S. Form W-9). Participants cannot receive payment without completing this paperwork but are welcome to participate without completing this paperwork if they waive access to a cash prize. Any person winning over $600 in cash prize(s) from the Company will receive an IRS form 1099 at the end of the calendar year and a copy of such form will be filed with the IRS by the County. A recipient of a cash prize may have other tax reporting obligations. The County makes no representation about tax requirements and participants acknowledge their individual responsibility for the determination and payment of any taxes due on prize money.
  5. Cash prize amounts awarded to a team will be split equally among all team members who are eligible to receive a cash award. Any change from this payment structure must be unanimously agreed upon by all members of the team in advance and provided to County in a writing signed and dated by all team members.

Intellectual Property

  1. During the course of the Event, teams will collaborate to create ideas, applications, webpages, and/or software. By participating in the Event, you, the participant, agree that any ideas, applications, webpages, and/or software you participate in creating will be jointly and severally owned by each member of your team. This means that each member of your team, regardless of their contribution, will have the full right to use the end product and any ideas created in any way they wish without having to gain additional permission from any other member of the team, including through the creation of derivative works, modification and/or commercialization of the product/idea, or licensing it.

    However, nothing in these Terms of Participation override or alter any terms of use or licenses associated with any third-party software or tools that you, the participant, or your team use during the Event, and all such third-party terms of use and/or licenses remain in effect.

    By signing below, participants grant the County the right to freely use any concepts or ideas generated during the Event for any purpose. If the County wishes to use a specific application or software created during the Event, the County will give written courtesy notification to each member of the team that created the specific application or software.

Waivers & Release

  1. I agree that participation in the Event is undertaken at my sole risk (or at the sole risk of my minor child or children, if applicable) and that the County of Marin, including its officers, employees, and representatives (hereafter "County"), will not be liable for any claims for injuries or damages whatsoever arising out of or connected with the Event. I hereby release County from any and all claims, demands, damages, costs, expenses, loss of services, actions, and causes of action belonging to the undersigned or arising out of any act or occurrence in connection with and particularly on account of all personal injury, disability, property damage, loss of damages of any kind sustained or that may hereafter be sustained arising during the Event except for claims proven to be caused by the sole gross negligent or willful misconduct of County .
  2. I hereby give consent for me (or on behalf of my minor children, if applicable) to receive medical treatment which may be deemed advisable in the event of injury, accident, or illness during the above-referenced Event.


Signature (for persons 18 years old or older):
I represent that I am over the age of eighteen (18) years, that I have read the Terms of Participation above and that I fully understand its contents, that I agree to be bound by the terms listed in this form, and that this agreement shall be binding upon me and my heirs, legal representatives, and assigns.

Participant signature: __________________________________________________

Printed name of participant: ___________________________________________

Signature date: ________________

Signature and Authorization (for persons younger than 18 years):
I hereby acknowledge that my child(ren)'s participation in this event is voluntary. I also understand that my child(ren)'s participation in this event carries with it certain inherent risks, and I hereby agree to accept and assume any and all risks of property damage, personal injury, or death that my child's participation may entail.

I further represent that: I am the parent or legal guardian of the minor children listed below; I am over the age of eighteen years; I have read this Terms of Participation form; I fully understand its contents; I am freely signing this agreement; I agree to be bound by the terms listed in this form; I agree to have the children listed below covered by the terms of this agreement; by signing this form I am giving up legal rights and/or remedies which may otherwise be available to my minor child(ren) participating in the Event and to myself, regarding any losses my minor child(ren) may sustain as result of his/her participation; and this agreement shall be binding upon me and my heirs, legal representatives, and assigns.

Name(s) of minor child(ren):

  • Name: _________________________________________________________________
  • Age:  _____
  • Name: _________________________________________________________________
  • Age:  _____

Signature of parent/guardian: ___________________________________________

Printed name of parent/guardian: _______________________________________

Signature date: ________________