Wild Hearts Kids Club - liability waiver and media release form

Participant's name

First NameLast Name

I, the undersigned parent/guardian of the above named student, do hereby consent to his/her participation in Wild Hearts Kids Club programs.*

I consent.

I acknowledge that participation in this program may expose the above named student to the possibility of injury. I grant Wild Hearts Kids Club staff the authority to obtain emergency medical treatment as necessary to ensure that the above named student is safe from further injury in case the participant's parent isn't present.*

I consent.

I understand that while Wild Hearts Kids Club staff strive to make the program as safe as reasonably possible, there exists always the possibility of injury or death due to the negligence of Wild Hearts Kids Club staff before or after an injury occurs. Negligence means the failure to exercise the due care that a reasonable person would exercise under the circumstances. By signing below I hereby waive my right to pursue legal action based upon illness, injury, or death to my child.*

I consent.

I hereby agree to indemnify and hold harmless Wild Hearts Kids Club from any loss, liability, damage, or cost of any and all kind they may incur due to the participation of the above named student in the program and any activities incidental thereto, whether caused by the negligence of Wild Hearts Kids Club or otherwise.*

I consent.

I agree that the above named student may appear in a photograph, or video, taken by staff or local media and that that photograph or video may appear in a variety of media sources on behalf of Wild Hearts Kids Club. Wild Hearts Kids Club will not divulge your child's name without written permission.

I consent.

I acknowledge that the above named student will be participating in activities, trips and events organized by Wild Hearts Kids Club. I am aware that the participation of my student may be outside the scope of his/her daily routine. I give permission for my child to travel by foot, automobile, bus, train, ferry, airplane, helicopter or spacecraft to a desired location.*

I consent.

Yes, please send me periodic updates regarding activities and events by Wild Hearts Kids Club LLC.

I consent.

Email

example@example.com

Name of participant's parent / guardian*

First NameLast Name