This is an important document: As Parent, fiduciary, representative, caregiver or Guardian (hereafter called "Guardian) for a Minor Child or Children, (hereafter called "the Minor" whether the Minor is over the age of 18 or not) who is participating in an activity involving the HELIANTHUS POSITIVE BEHAVIOR SUPPORTS (hereafter called "HPBS") on the date signed below, hereafter known as "the activity", in order for the Minor to participate in the activity, you must sign this Waiver, Release of Liability, Acknowledgement of Risk and Indemnity Agreement (hereafter called "this waiver") before the Minor may participate. Read this document very carefully before you sign. This waiver is applicable for as long as the Minor participates in any HPBS activity, and until three years after the end of the activity or the Minor's nineteenth birthday, whichever is later.
In consideration for allowing the Minor to participate in the activity, I, for myself, the Minor, and for my and the Minor's representatives, heirs, next of kin, successors, assigns and personal representatives do hereby freely and voluntarily, without duress, execute this waiver under the following terms:
Waiver and Release: As the guardian for the Minor, I and the Minor release and forever discharge and hold harmless HPBS and its past and present affiliates, assigns, successors in interest, agents, servants, employees, volunteers, participants, officers, directors and sponsors (hereafter called "Released Parties") from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the Minor’s participation in the activity.
I understand and agree that this release will have the effect of releasing, discharging, waiving, and forever relinquishing any and all actions or causes of action that I and/or the Minor may have, whether past, present or future, whether known or unknown, arising from, resulting from, or in connection to the activity. This release constitutes a complete release, discharge and waiver of any and all actions or causes of action that I or the Minor may have against the Released Parties, including but not limited to any claims for personal injury, property damage, or wrongful death and including but not limited to any injuries resulting from negligent actions or omissions. I also understand that HPBS does not assume any responsibility for or obligation to provide financial assistance or other assistance to or for the Minor, including but not limited to medical, health or disability insurance in the event of injury, illness, death or property damage which occurs during the activity.
Acknowledgement of Risk: As guardian for the Minor, I acknowledge and understand fully that there are risks and dangers of serious bodily injury and death that could result from the Minor’s participation in the activity. I understand that in order to for the Minor to be allowed to participate in the activity, I agree to fully accept and assume all risks and all responsibility for any injury, losses and damages to person or property that my child may incur as a result of my child’s participation in the activity. I further acknowledge and understand that child care will be provided by staff and/or volunteers who may not have specific special needs sports safety training and have not gone through the screening process required by regular schools/day care providers. I understand and agree that I am required to remain available and on call on the premises of the activity while the Minor child is attending the activity.
Indemnity: I further agree to defend and indemnify HPBS for any claims brought by or on behalf of the Minor arising out of the activity, and for any claims brought by or on behalf of any other party arising from the Minor's participation in the activity.
Photographic/Audio Release: I irrevocably authorize HPBS to use my and the Minor’s recorded voice, image and likeness in any medium including, without limitation, video, photograph, film, tape, and digital medium, for any lawful purpose. I understand that neither I nor the Minor will receive any compensation for the use of my or the Minor's recorded voice, image and likeness in promotional materials and waive rights to any compensation now or in the future.
Statement of Confidentiality: I, the understated that while participating in Helianthus Positive Behavior Support Groups I may hear about other participants’ information, particularly during the drop off and pick up settings. I therefore agree to hold confidential my exposure, and knowledge of all consumer names, diagnoses, and associated individualized programs.
I have read this Waiver and fully understand its contents. I am aware that this is a release of liability and I sign of my own free will. I intend this to be a complete and unconditional release of all liability to the greatest extent allowed by the law, even though that liability may arise from the negligence or carelessness of the Released Parties listed above, and I agree that if any portion of this agreement is held to be invalid, the remaining portion of the agreement shall continue to be in full force and effect.