Registration Form

In consideration for participating in First Love You and or Fly Self Empowerment LLC’s courses, programs, seminars, retreats or any of the like (hereinafter the “Activity” or “Activities”) I, on behalf of myself and any minor child/children for who, I have the capacity to contract, hereby acknowledge and agree to the following:

1. I certify that I am the PARENT OR GUARDIAN of the MINOR child/children for which I am executing this WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT. “I” will be defined herein and hereafter as myself, and the parent or guardian on behalf of the child/children their heirs assigns and representatives.
2. I understand the hazards of the novel coronavirus (“COVID-19”) and am familiar with the Centers for Disease Control and Prevention (“CDC”) guidelines regarding COVID-19. I acknowledge and understand that the circumstances regarding COVID-19 are changing from day to day and that, accordingly, guidelines, including but not limited to the CDC’s are regularly modified and updated and I accept full responsibility for familiarizing myself with the most recent updates available for COVID-19.
3. Notwithstanding the risks associated with COVID-19, which I readily acknowledge, I hereby willingly choose to participate in Activities
4. I acknowledge and fully assume the risk of illness, injury or death related to COVID-19 arising from my being on the premise and participating in the Activities and hereby RELEASE, WAIVE, DISCHARGE and COVENANT NOT TO SUE (on behalf of myself and any minor children from whom I have the capacity to contract) First Love You and FLY Self Empowerment LLC, its owners, officers, directors, agents, employees assigns (the “RELEASEES”) from any liability related to COVID-19 which might occur as a result of me being on the premises and participating in the Activities.
5. I shall indemnify, defend and hold harmless the RELEASEES from and against any and all claims, demands, suits, judgments, losses or expenses of any nature whatsoever (included without limitation, attorneys fees, costs, disbursements, which of in-house counsel or outside counsel and whether or not an action is brought on appeal or otherwise) arising from or out from or relating to , directly or indirectly, the infection of COVID-19 or any other illness or injury.
6. I agree that any suit, claim or demand shall be brought in The County of Will in the State of Illinois.
7. It is my express intent that this Waiver and Hold Harmless Agreement shall bind any heirs, assigns and representatives, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEES. This Agreement and the provisions contained herein shall be construed, interpreted and controlled according to the laws of the State of Illinois. I HEREBY KNOWINGLY AND VOLUNTARILY WAIVE ANY RIGHT TO A JURY TRIAL OR ANY DISPUTE ARISING IN CONNECTION WITH THIS AGREEMENT. I ACKNOWLEDGE THAT THIS WAIVER WAS EXPRESSLY NEGOTIATED AND IS A MATERIAL INDUCEMENT OF THE PERMISSION GRANTED BY RELEASEES TO BE ON PREMISES AND PARTICIPATE IN THE ACTIVITIES.

IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Wavier of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Agreement for full, adequate and complete consideration fully intending to be bound by the same.

THE PARENT OR GUARDIAN HAS READ THE FOREGOING WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT AND DOES SO VOLUNTARILY AND WITH THE UNDERSTANDING THAT SUBSTANTIAL RIGHTS ARE BEING GIVEN UP HEREIN.

In consideration for participating in First Love You and or Fly Self Empowerment LLC’s programs, seminars, sessions, retreats or any of the like (hereinafter the “Activity” or “Activities”) I, on behalf of myself and any minor child/children for who, I have the capacity to contract, hereby acknowledge and agree to the following:

1. I certify that I am the PARENT OR GUARDIAN of the MINOR child/children for which I am executing this WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT. “I” will be defined herein and hereafter as myself and the parent or guardian on behalf of the child/children their heirs, representatives and assigns.
2. I am participating in Activities during which I will receive information and instruction. I recognize that I may engage in physical activity and I am fully aware of the risks and hazards involved.
3. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any physical program, including but not limited to this Activity.
4. In consideration for being permitted to participate in First Love You or Fly Self Empowerment LLC’s programming I agree to assume full responsibility for any risks, injuries or damages, know or unknown, which I might incur as a result of participating in the program.
5. I acknowledge and fully assume the risk of injury, illness or death related to or arising from my being on the premise and participating in the Activities and hereby RELEASE, WAIVE, DISCHARGE and COVENANT NOT TO SUE (on behalf of myself and any minor children from whom I have the capacity to contract) First Love You and FLY Self Empowerment LLC, its owners, officers, directors, agents, employees assigns (the “RELEASEES”) from any liability related to or which might occur as a result of me being on the premises and participating in the Activities.
6. I shall indemnify, defend and hold harmless the RELEASEES from and against any and all claims, demands, suits, judgments, losses or expenses of any nature whatsoever (included without limitation, attorneys fees, costs, disbursements, which of in-house counsel or outside counsel and whether or not an action is brought on appeal or otherwise) arising from or out from or relating to , directly or indirectly, from my participation in the Activities.
7. I agree that any suit, claim or demand shall be brought in The County of Will in the State of Illinois.
8. I acknowledge and attest to the fact that the RELEASEES are not trained medical professional, not licensed psychologists or health care professionals. The RELEASEES Activities and Services do not replace the place of psychologists or other healthcare professionals.
9. I acknowledge and attest to the fact that the Activities are in no way to be construed, understood or substituted as psychological counseling or any other type of therapy or medical advice.
10. I acknowledge and attest to the fact that any information disbursed, disseminated, communicated by the RELEASEES is not medical advice and will not be taken or relied upon as such.
11. I consent for my child/children to receive such medical treatment and/or surgical procedures as are deemed necessary in the event of an emergency and I assume all liability for any medical expenses involved. This authorization extends to my child’s participation in any Activities. Should a medical emergency arise during my child’s participation in Activities, I understand that if circumstances permit, reasonable efforts will be made to contact me or my designated alternate by the phone numbers given. If it is believed my child’s life or health may be adversely affected by the delay that an attempt to contact me or my designated alternate would cause, I consent to the administration of medical treatment and/or surgical procedure deemed necessary by the medical doctor and/or medical staff and medical facility and the immediate administration of life-sustaining measures deemed necessary under the circumstances. I agree to be responsible for any and all expenses incurred as a result of said treatment and agree to Hold Harmless RELEASEES of the same.
12. I give permission for the use of any photos, movies, videos and audio or video taping of my child’s activities in Activities. The material so obtained may be employed by First Love You or FLY Self Empowerment LLC for promotional purposes and programming including but not limited to social media and the Self Love You and or Fly Self Empowerment website.
13. It is my express intent that this Waiver and Hold Harmless Agreement shall bind any assigns and representatives, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEES. This Agreement and the provisions contained herein shall be construed, interpreted and controlled according to the laws of the State of Illinois. I HEREBY KNOWINGLY AND VOLUNTARILY WAIVE ANY RIGHT TO A JURY TRIAL OR ANY DISPUTE ARISING IN CONNECTION WITH THIS AGREEMENT. I ACKNOWLEDGE THAT THIS WAIVER WAS EXPRESSLY NEGOTIATED AND IS A MATERIAL INDUCEMENT OF THE PERMISSION GRANTED BY RELEASEES TO BE ON PREMISES AND PARTICIPATE IN THE ACTIVITIES.

IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Wavier of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement have been made; I am at least eighteen (18) years of age and fully complete; and I execute this Agreement for full, adequate and complete consideration fully intending to be bound by the same.

THE PARENT OR GUARDIAN HAS READ THE FOREGOING WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT AND DOES SO VOLUNTARILY AND WITH THE UNDERSTANDING THAT SUBSTANTIAL RIGHTS ARE BRING GIVEN UP HEREIN.