This form must be filled out as completely as possible and signed in order for your child to participate in activities at Glitter Barn. This form goes into effect immediately and does not expire.

MEDIA RELEASE

Glitter Barn requests your permission to reproduce through printed, audio, visual, or electronic means activities in which you and/or your child(ren) has/have participated. Your authorization will enable us to use specially prepared materials to increase awareness of our educational programs through the use of mass media, displays, brochures, websites, etc. When used in a public realm, identifying information (name, school, etc.) will not be attached to any specific picture or image.

​I, as a parent or guardian, of the above named child, fully authorize and grant The Glitter Barn LLC and its authorized representatives, the right to print, photograph, record, and edit as desired, the image, likeness, and/or voice of the above named child on audio, video, film, slide, or any other electronic and printed formats, currently developed, (known as “Recordings”), for the purposes stated or related to the above.  I understand and agree that use of such Recordings will be without any compensation to the child or the child’s parent or guardian. I understand and agree that The Glitter Barn LLC and/or its authorized representatives shall have the exclusive right, title, and interest, including copyright, in the Recordings. I understand and agree that The Glitter Barn LLC and/or its authorized representatives shall have the unlimited right to use the Recordings for any purposes stated or related to the above. I hereby release and hold harmless The Glitter Barn LLC and its authorized representatives from any and all actions, claims, damages, costs, or expenses, including attorney’s fees, brought by the child and/or parent or guardian which relate to or arise out of any use of these Recordings as specified above.

Medical Release

I, the undersigned parent/guardian of {childsName} hereby authorize The Glitter Barn LLC and its staff, into whose care the above minor child has been entrusted, to obtain proper medical care from a licensed medical or dental doctor or facility. The medical/dental care is to include, but is not limited to, any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which the aforementioned physician or dentist in the exercise of this best judgment may deem advisable. This authorization shall include transportation to receive the medical or dental care. In the event of injury or illness to my child/ward, I agree that my healthcare insurer and I shall be financially responsible for any medical treatment required by child/ward as a result of any injury or illness suffered during his/her participation in any activities provided by The Glitter Barn LLC.

General Liability Waiver and Indemnity

I have considered the risks activities at Glitter Barn and I am aware of the hazards involved in such activities. I have considered these risks and I still wish for my child to participate. By sending my child to activities at Glitter Barn, I agree to release, waive, discharge, and covenant not to sue The Glitter Barn LLC or its affiliated entities, directors, board members, employees, staff, members, volunteers, vendors, agents, representatives, attorneys, predecessors, successors and assigns (collectively, “Releasees”) from any and all liability for any loss or damage, and any claim or demands, for any and all injuries incurred while visiting the Glitter Barn or participating in any Glitter Barn activity, whether or not caused by any alleged act or omission of the Releasees. I further agree to indemnify and hold harmless Glitter Barn and the Releasees against any and all claims, causes of action or lawsuits, for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including any attorneys’ fees or related costs or medical bills or costs which may arise related to my/my child's visit to Glitter Barn or participation in any Glitter Barn activity.

Covid-19 Assumption of risks: COVID-19 is reported to be extremely contagious. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illnesses and even death.  I agree to have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize Glitter Barn services and enter Glitter Barn premises.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

 

By signing below, I state that I have read, understand, and agree to the terms of this agreement.