FACETS THEATRE ACTIVITY
Subject to the terms herein, the Participant will attend and participate in the Facets Theatre activity (the “Activity”). I am solely responsible for transportation of the Participant to and from the Activity.
CONSENT, RELEASE, & MEDICAL AUTHORIZATION
By signing and submitting the Facets Theatre Registration Form, Facets Theatre Medical Form, and Facets Theatre Participant Consent and Release Form (collectively, the “Agreement”) for Facets Theatre, I give my permission for the above Participant, who is either myself, my child or legal ward (“the participant(s)”), to attend the Activity. I voluntarily and freely assume any and all risks of accident, liabilities, injury, illness, or damage to or loss of property which the participant(s) may sustain as a result of participating in the Activity with Facets Theatre.
I declare that the participant(s) is in good health and has no mental or physical condition or symptoms that could interfere with his or her safety or the safety of others while participating in the Activity with Facets Theatre. Furthermore, I certify that I have adequate health insurance to cover any injury or damage that the participant(s) may suffer while participating in the Activity with Facets Theatre, or alternatively, I agree to bear all costs associated with any such injury or damages to the participant(s).
Should a medical emergency arise with respect to the participant(s), as such emergency is determined to exist in the discretion of Facets Theatre, I hereby authorize the Facets Theatre, hospitals, licensed medical or dental providers, and their agents and employees to have access to the information contained in the Agreement and to provide all medical or dental care, routine tests, treatment, and necessary transportation advisable for the health and safety of the participant(s). This includes the authority to consent to any x- ray examinations, anesthetic, medical procedure or treatment, and hospital care under the supervision, and upon the advice of or to be rendered by, a physician or surgeon licensed under the Medical Practice Act or dentist licensed under the Dental Practice Act for the participant(s). This authorization constitutes a waiver of any applicable provisions of the Health Insurance Portability and Accountability Act (“HIPAA”). Although Facets Theatre has Emergency Contact Information as provided in the Agreement, actually reaching a listed Emergency Contact is not a prerequisite to the provision of medical or dental treatment, or the disclosure of medical information as set forth in this paragraph. I will be responsible for payment of any and all medical services rendered. I further authorize those in charge of Facets Theatre to receive physical custody of the participant(s) upon completion of any treatment, and I specifically instruct any treating health facility to surrender physical custody of the participant(s) to said adult.
I, the undersigned, do hereby release, hold harmless, defend, indemnify, waive and discharge the Facets Theatre, the University of Dayton, and its officers, agents, students, and employees from and against any and all claims, demands, actions or causes of action arising from any injuries or damages the participant(s) may suffer, sustain, or cause by his or her participation in Facets Theatre at the University of Dayton.
By signing below, I represent that I am myself, a custodial parent or legal guardian of the individual identified as “the participant(s)” in the Facets Theatre Registration Form, I have all rights as a parent or legal guardian of a minor child under Ohio law, and have the authority to execute this waiver and release on behalf of his/her and my interests.
EMERGENCY COMMUNICATIONS
In the event of an emergency, Facets Theatre will use reasonable attempts to contact the parents/guardians and emergency contacts listed on the Facets Theatre Registration Form, until a “live” person is reached or responds. Note that, as outlined under the “Medical Authorization” section above, emergency care may be provided prior to establishing contact with a parent/guardian and/or emergency contact. A parent/guardian or other emergency contact with information or questions regarding a real or potential emergency contact should contact the emergency contact person for the Facets Theatre, Michelle Hayford at 937.818.2757.
GOVERNING LAW
This Agreement will be governed by and interpreted in accordance with the laws of the State of Ohio, without giving effect to the principles of conflicts of law of such state. I agree that any action arising out of this Agreement must be brought exclusively in any state or federal court located in Ohio.
SURVIVAL
Any provision of this Agreement providing for performance by either party after termination of this Agreement shall survive such termination and shall continue to be effective and enforceable.
COMPLIANCE WITH LAWS
In the performance of this Agreement, the parties shall comply with all applicable federal, state, regional and local laws, rules and regulations.
AGREEMENT
I HEREBY ACKNOLWEDGE THAT I HAVE FULLY READ AND UNDERSTAND EACH OF THE PROVISIONS CONTAINED IN THIS AGREEMENT. I EXECUTE THIS AGREEMENT VOLUNTARILY AND FOR ADEQUATE CONSIDERATION INTENDING TO BE FULLY BOUND. In consideration for attending and participating in the Activity, I hereby agree to the participant(s) participation in the Activity on all the terms detailed in this Agreement.