to receive occupational therapy treatment at Marin Superstars operated by Wonder Land OT and Wellness P.C.
I hereby agree to indemnify and hold Wonder Land Occupational Therapy and Wellness P.C., Marin Superstars and all its officers, directors, employees, representatives and volunteers harmless from and against any and all liabilities for any injury which may be suffered by me or by my child(ren) arising out of or in any way connected with participation in Wonder Land Occupational Therapy and Wellness P.C. and Marin Superstars group OT program. In the case of a medical or surgical emergency, I hereby give permission, to any medical personnel selected by the staff, to secure proper treatment. I give my full permission for my child(ren) to participate in activities, including but not limited to climbing, running, use of balls, bats and rackets, and I acknowledge that group activities may contain an inherent risk of injury.
Assumption of Risk: I understand the participation of my child in the services provided by Wonder Land Occupational Therapy and Wellness P.C. and Marin Superstars group program carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injury. The specific risks vary from one activity to another but the risks range from minor such as scratches and bruises to serious injuries and consequences. I am voluntarily participating in these Services with knowledge of the danger involved, and agree to assume any and all risks of bodily injury, death or property damage, whether those risks are known or unknown, regardless of the location of the services.
Indemnification: I agree to indemnify, hold harmless, and defend Wonder Land Occupational Therapy and Wellness P.C. and the therapists and coaches from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees, arising out of Wonder Land Occupational Therapy and Wellness P.C.'s and therapists’ and coaches' involvement in the services, regardless of the location of the provision of services, and to reimburse the same for any such expenses incured. Any controversy or claim arising out of or related to my child(ren)’s participation in this group will be attempted to be settled by a professional mediation service, then by binding arbitration pursuant to the applicable rules of the American Arbitration Association.
I acknowledge that I understand that the group is non-refundable unless Marin Superstars has been advised to cancel the group by public health officials. If a day needs to be cancelled, there may be a makeup day added at the end of the session or the pro-rated amount for the missed date may be applied to future services.
Wonder Land Occupational Therapy and Wellness P.C. and Marin Superstars takes your health and safety very seriously and fully intend to protect and keep your child safe.