Youth Leadership Academy Summer Program
Liability Waiver/Photo & Voice Release
In consideration of the opportunity to participate in the Youth Leadership Academy Summer Program, the Minor, and Parent or Legal guardian acknowledges and agree, as follows:
I, the undersigned parent or legal guardian of {childsName} a minor, do hereby CONSENT to his/her participation Youth Leadership Academy Summer Program from {date}. Minor and Parent or legal guardian understand that Youth Leadership Academy during the summer program offers a variety of activities, including vigorous sports and games, gym sports, field sports, field trips, tours, target sports, exercise, fitness, and other activities, including crafts, science experiments, and creative projects. A list of the activities offered has been made available to us, and summer program activities are described, including photos, on our website (hereafter referred to as the activity). Risks of our Summer Program activities are inherent in the Youth Leadership Academy Program experience; that is, they cannot be eliminated without significantly altering the nature of the activities and reducing their value and appeal. These risks include those associated with the elements of nature, including heat, cold, rain, wind, lightning, and fire; falls and abrupt and forceful contact with manmade and natural structures; close personal contact and physical trauma associated with sports and other recreation; errors of judgment, failure to follow instructions, and careless conduct of other Minors, staff and other persons with whom the summer program may contract for certain services; and other risks ordinarily associated with summer program activities and vigorous recreation in a rugged outdoor environment. Minor may suffer cuts, fractures and sprains, insect, and other animal bites, plant and other allergies, food, and water-related ailments, trauma from contact with other persons and objects, heat and cold from exposure to the natural elements, emotional upset and, in extraordinary cases, death, including by drowning and/other risks may be encountered. Minor and Parents understand the activities and risks of the Youth Leadership Academy Summer Program, including those described above. The undersigned parent or legal guardian (Parent, for himself or herself and on behalf of Minor), acknowledges and assumes all risks of Youth Leadership Academy Summer Program's enrollment and participation in the activities of the 2024 Summer Program, whether or not described above, and inherent or not.
I understand and agree that Youth Leadership Academy Summer Program Rules must be strictly observed, and Minor may be dismissed from the program, and sent home, in the event of violations of these or other requirements of the program administration.
I, RELEASE, and discharge to the maximum extent allowed by law to Youth Leadership Academy and its owner(s), director(s), employee(s), staff (including volunteers and visiting instructors and clinicians), agent(s), independent contractors, suppliers, and sponsor(s) (hereinafter collectively referred to as "Released Party") with respect to any and all liability and claims, for property loss, personal injury, death or otherwise, losses or expenses of whatever kind or nature arising in whole or part from Minor's enrollment or participation in summer program activities or his or her presence during summer program at Youth Leadership Academy premises. I also RELEASE and discharge Youth Leadership Academy from any and all claims, damages, losses or expenses of whatever kind or nature which said minor may have or acquire arising out of or resulting from, directly or indirectly, his/her participation in this activity.
I agree to hold harmless and indemnify (meaning to protect and pay claims and damages, including costs and attorney’s fees) the Released Parties and each of them from and against all claims, by whomever they may be brought (including family members and others) arising in whole or part from a loss incurred by Minor or caused by Minor related to his or her enrollment or participation in Summer program activities or presence on Youth Leadership Academy‘s premises.
I understand and agree that these agreements of release and indemnity include, but not exclusively, claims based in whole or part on a Released Party's alleged or actual negligence (but not gross negligence or intentional wrong conduct).
I hereby authorize Youth Leadership Academy’s owner(s), director(s), employee(s), staff (including volunteers and visiting instructors and clinicians), agent(s), independent contractor(s), or who is supervising said minor, to act on our behalf in authorizing and consenting to emergency medical care including surgery, if necessary and/or if the parent or legal guardian cannot be reached, or circumstances do not permit to locate parent in a situation which the minor consider a medical emergency which may include (but it is not limited to) hospitalization and/or dental care for said minor if he/she becomes ill or is injured while participating in the activity. This Authorization and Consent may be presented to the appropriate medical/dental staff at such time as emergency medical care, dental care, ordering of injection, anesthesia, hospitalization, and other medical care is required including exchanging medical information with a third-party caregiver. I hereby RELEASE and discharge Youth Leadership Academy from all claims of any nature whatsoever, which may arise out of the decision to provide emergency medical care, dental care or hospitalization during the activity.
I understand and agree that by signing this release form, I authorize Youth Leadership Academy to use the following personal information about my son/daughter:
(1) picture – including photographic, motion picture, and electronic (video) images.
(2) voice – including sound and video recording.
I hereby grant to Youth Leadership Academy, its subsidiaries, licensees, successors, and assigns, the right to use, publish, and reproduce, for all purposes, the name of the camper, pictures of the Minor in film or electronic (video) form, sound and video recording of Minor’s voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats, and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing.
I further grant Youth Leadership Academy all rights, titles, and interests that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Youth Leadership Academy the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.
I hereby waive the right to review any payment for signing this release and waive the right to receive any payment for Youth Leadership Academy’s use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer-generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it may be applied.
I understand and agree that If a dispute arises between the Minor or Parent and the Youth Leadership Academy that cannot be resolved by agreement, the Parent, for himself or herself and on behalf of the Minor, agrees to submit the dispute for mediation to a mediator registered with or otherwise recognized as such by the Courts of Cameron County, Texas, where such mediation shall be conducted.
I have read the above agreement, understand, and accept its terms and consequences, and freely, voluntarily, and knowingly sign this waiver.