LUCY’S LOVE BUS CHARITABLE TRUST, INC.
RELEASE AND WAIVER OF RIGHTS
This Release and Waiver of Rights (hereinafter, this “Waiver”) is made on behalf of the minor child {fullName3} (hereinafter, “Child”), as well as on their own behalf by Child’s undersigned parent(s) and/or legal guardian(s) (hereinafter, “Parent(s)”). Parent(s) have requested the assistance of Lucy’s Love Bus Charitable Trust, Inc. and its respective volunteers, officers, directors, employees, agents, and affiliates (collectively, “Lucy’s Love Bus”) in identifying and collaborating with third party providers of certain services (hereinafter, “Provider(s)”). Providers specialize in services including, but not limited to, acupuncture, massage, therapeutic horseback riding, Reiki, meditation, tai chi, art, music, dance, fertility preservation, therapies, medical support and other activities (collectively, “Services”), such that Providers can render their Services directly to Child.
Parent(s) hereby acknowledge and understand that Lucy’s Love Bus identifies, partners with, and makes referrals to Providers. Parent(s), however, understand that Parent(s) are ultimately wholly responsible for and assume the entire risk of and determination as to whether a Provider and/or Provider Services are safe and proper for Child. Such determination includes, but is not limited to, whether a Provider is qualified and fit to adequately perform Services for Child. Parent(s) further acknowledge and understand that Parent(s) should consult with Child’s medical professionals as to whether Provider Services could potentially harm Child. Parents(s) also acknowledge and understand that Provider Services and/or the location of Provider Services have the potential to pose certain risks which could lead to injuries and even death of Child.
In consideration of Lucy’s Love Bus’s identification of Providers and other services:
1. PARENT(S) HEREBY REPRESENT AND WARRANT THAT THEY ARE THE PARENT(S) AND/OR LEGAL GUARDIAN(S) OF CHILD, AND HEREBY AGREE TO THE TERMS HEREIN ON THEIR OWN BEHALF, AND ON BEHALF OF CHILD. Parent(s), by their execution of this Waiver, agree and assent to the terms hereof and execute this Waiver on behalf of their minor child, Child, intending to be legally binding and fully enforceable against both Child and themselves, and their respective heirs.
2. PARENT(S) HEREBY ACKNOWLEDGE AND FULLY ASSUME THE RISKS INHERENT IN PROVIDER SERVICES. Such risks may include, but are not limited to, physical or psychological injury, property damage, or other physical, economic, or emotional losses, or other damages caused in part or in whole by the location of the activities, personal negligence, or the negligence of others, among other potential contributing factors. After consideration of the risks inherent in Provider Services, including, but not limited to, those contemplated herein, Parent(s) hereby acknowledge and fully assume any and all risks in connection with referral by Lucy’s Love Bus and Parent(s)’ and/or Child’s participation in any and all Provider Services.
3. PARENT(S) HEREBY WAIVE ANY AND ALL CLAIMS AGAINST LUCY’S LOVE BUS, BOTH ON THEIR OWN BEHALF AND ON BEHALF OF CHILD. Parent(s) agree to waive and release and promise to indemnify, reimburse, defend, and hold harmless Lucy’s Love Bus against any and all legal or equitable claims and proceedings of any description, known or unknown, that Parent(s), Child, and/or their respective heirs, have or may have in the future, directly or indirectly, against Lucy’s Love Bus for any losses, damages, expenses, or injuries, including, but not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, property damage, and death, suffered from, or in connection with, referral by Lucy’s Love Bus and/or participation in any and all Provider Services.
4. PARENT(S) HEREBY AGREE, AND AGREE ON BEHALF OF CHILD, THAT, TO THE EXTENT ALLOWED BY APPLICABLE STATUTE OR CASE LAW, THIS WAIVER IS ALSO FOR NEGLIGENCE ON THE PART OF LUCY’S LOVE BUS. Parent(s) acknowledge and understand that the injuries and outcomes contemplated herein may arise from the negligence of others. Parent(s) hereby agree, and agree on behalf of Child, that, to the extent allowed by applicable statute or case law, Lucy’s Love Bus shall not be liable to either Parent(s) or Child for any negligence by Lucy’s Love Bus in connection with its referral of Providers or other services.
5. PARENT(S) HEREBY AGREE, AND AGREE ON BEHALF OF CHILD, TO ARBITRATION, IN ACCORDANCE WITH MASSACHUSETTS LAW, IN THE EVENT OF ANY DISPUTE. In the event a dispute shall arise between Parent(s) or Child and Lucy’s Love Bus out of or relating to this Waiver or the construction, interpretation, performance, termination, enforceability or validity of this Waiver, Parent(s) hereby agree to binding arbitration in accordance with the then applicable American Arbitration Association Commercial Rules of Arbitration. Further, Parent(s) hereby agree that such arbitration shall be the agreed upon exclusive dispute resolution for any and all matters arising between the parties to this Waiver, now or in the future. In the event of arbitration, Parent(s) and Lucy’s Love Bus shall mutually agree on a single arbitrator. In the event that Parent(s) and Lucy’s Love Bus cannot agree on a single arbitrator, each party shall appoint an arbitrator and those chosen arbitrators shall, in turn, mutually agree on a third arbitrator for a complete panel of three arbitrators. The dispute(s) shall then be resolved by the single chosen arbitrator or the panel, in either case applying the substantive law of The Commonwealth of Massachusetts without regard to any applicable choice of law rules. Any decision or award rendered by an arbitrator or panel shall be final and legally binding, and judgment may be entered thereon.
Each party shall be responsible for its share of costs associated with arbitration. In the event a party fails to proceed with arbitration, unsuccessfully challenges the arbitrator’s award, or fails to comply with the arbitrator’s award, that party shall reimburse the other party for costs of the legal suit, including reasonable attorney’s fees, for having to compel arbitration or to defend or enforce the award.
6. PARENT(S) HEREBY AUTHORIZE AND CONSENT TO PARTICIPATION OF CHILD IN PROVIDER SERVICES. Parent(s) acknowledge and understand that referral to and participation in Provider Services is completely voluntary, and that Parent(s) and Child are free to not participate in any Provider Services. After consideration of the risks inherent to participating in Provider Services, Parent(s) hereby consent to, and authorize, Child’s participation in any and all such Services with full knowledge that Lucy’s Love Bus will not be liable to Parent(s) or Child for any related personal injuries or property damage that may occur.
Parent(s) hereby acknowledge that they have read, understood, and agreed to this Waiver in its entirety, including, but not limited to, the above paragraphs numbered one through six (1 – 6). Parent(s) hereby agree that signing below binds themselves, Child, and their respective heirs, successors, assigns, and estates to the terms and conditions described herein. Parent(s) further acknowledge that by signing below they have entered into this Waiver willingly and knowingly, without fraud, duress, or coercion by Lucy’s Love Bus. Parent(s) hereby agree that this Waiver is an accurate understanding of the entire agreement between the parties on the subject, that neither party has relied on any outside representation or statement on the matters described herein, and that this Waiver has not been modified orally. Parent(s) hereby agree that if any provision of this Waiver is or becomes illegal, unenforceable, or invalid in any jurisdiction for any reason, it shall not affect the enforceability or validity of any other provision of this Waiver.