JosiahKids Incorporated Waiver Form

JosiahKids Liability Release Waiver

A waiver must be completed for each family participating in any of our programs, including but not limited to: (Community Service, Athletics, Virtual or In-person Learning, Music, Dance, The Buford Harvest, and Annual Award Ceremony).
My relationship to the student(s) I am completing this waiver for is: *

Father Mother Legal Guardian
In consideration of the child or children being allowed to participate in (ALL) activities and programs of JosiahKids Incorporated--virtually, and/or in person, (including but not limited to) educational workshops, guest speaker events, purposeful play, developmental classes, dance, musical performances, sports activities and all events related to the program:
I agree to the following: *

I affirm that I have been made aware that JosiahKids Incorporated is an organization of volunteers, contractors and staff, open to serving children and families of all backgrounds and faiths with programs and services which build spirit, mind, soul and body. I acknowledge that I have been informed that JosiahKids Incorporated is a nonprofit organization founded on a Judeo-Christian faith and heritage, upholding the values of the Bible. I acknowledge that I have been informed that JosiahKids Incorporated is not a licensed child care facility. I also understand that this program is not required to be licensed by the Georgia Department of Early Care and Learning and this program is exempt from state license requirements. I hereby authorize (JosiahKids Incorporated) whether in-person or virtually, to take, record and publish the photographs and videos taken of me and or the undersigned minor child, and our names, for the use of printed brochures, publications, websites, teaching, discipleship and or training purposes. I attest that I am the parent or legal guardian of the child listed below and that I have the authority to authorize JosiahKids to use the photographs, videos and names of the minors I represent. I acknowledge that neither the minor child nor I will receive financial compensation for any photos or videos used by JosiahKids. I agree that participation in any publication, website, or brochure produced by JosiahKids confers no rights of ownership whatsoever. I release JosiahKids, its contractors and its employees, board members, volunteers and staff from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children in this program. The undersigned parent/ legal guardian of the participating student hereby acknowledges and agrees that participating in the program carries with it potential risk of unintended injuries which may be small or significant. The undersigned hereby acknowledges these possibilities, and assumes risk of such possible injury. I am aware of the risks and assume the responsibilities associated with participation in all the activities JosiahKids offers. I assume financial and legal responsibility for any injury or injuries suffered during participation in the program. Recognizing the possibility of physical injury associated and in consideration for JosiahKids Incorporated accepting the registrant for its programs and activities, I hereby release, discharge and/or indemnify JosiahKids, its directors, coaches, sponsors, donors, employees, volunteers, and associated personnel, including the facilities utilized for the Programs, against any claim, loss, damage or other disability. JosiahKids Incorporated, its teachers, staff, volunteers or agents are not responsible for accidents, and medical, and dental expenses incurred as a result of participation in the program. My child is covered by family/personal insurance. My child is in good health and has professional clearance by a medical doctor to participate in the physical activity of a rigorous program. For myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, hereby indemnify and hold harmless all the above releases from any and all liabilities incident to my involvement or participation in these programs even if arising from their negligence, to the fullest extent permitted by law. The undersigned parent/legal guardian understands that while JosiahKids will take prudent precautions, participation in the digital global learning virtual sessions involve potential risks, including without limitation, risk of cyber-attacks. I voluntarily assume responsibility for all risks of my child's participation in these digital learning virtual sessions. I further agree, I will closely supervise my child's online activities and participation.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

By signing below, I agree to each statement above and release JosiahKids Incorporated from any and all liability.
Date *

Month Day Year
Date
Full (Legal) Name of Parent or Legal Guardian completing this form: *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Signature *

Clear
Full (Legal) Name of Student # 1 - this form is being completed for: *

First Name Last Name
Full (Legal) Name of Student # 2 - this form is being completed for:

First Name Last Name
Full (Legal) Name of Student # 3 - this form is being completed for:

First Name Last Name
Full (Legal) Name of Student # 4 - this form is being completed for:

First Name Last Name
Full (Legal) Name of Student # 5 - this form is being completed for:

First Name Last Name
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JosiahKids Liability Release Waiver