I ** (“I” or “Me”), am the adult legal guardian of * * (“Child”), a minor child who desires to participate in the Teen Advocacy Fellow program organized and led by the National Alopecia Areata Foundation (“NAAF”), a California 501(c)(3) nonprofit organization headquartered in San Rafael, California. In recognition of my Child being permitted to participate in the Teen Advocacy Fellow program, and in recognition of NAAF’s reliance hereon, I agree to all the terms and conditions set forth in this Release of Liability and Assumption of Risk (this “Release”) as related to both myself and Child.
1. I acknowledge and agree that my Child must abide by all rules, regulations, and instructions provided by NAAF and that my Child is/are fully capable of participating as a Teen Advocacy Fellow and related activities.
2. I hereby grant NAAF, its agents or volunteers, the right to use any and all artwork, images or quotations made by my child in NAAF brochures, literature, or other public relations activities. I understand that my Child will not be identified by their full name.
3. I hereby expressly waive and release (on my own behalf and that of Child) any and all claims, now known or hereafter known, against NAAF, and its officers, directors, managers, employees, agents, affiliates, successors, and assigns (collectively, "Releasees"), on account of injury, disability, or death arising out of or attributable to my Child’s participation in the Teen Advocacy Fellow program, whether arising out of the ordinary negligence of NAAF or any Releasees or otherwise. On my own behalf and that of the Child, I covenant not to make or bring any such claim against NAAF or any other Releasee, and forever release and discharge NAAF and all other Releasees from liability under such claims. This waiver and release does not extend to claims for gross negligence, willful misconduct, or any other liabilities that California law does not permit to be released by agreement.
4. On my own behalf and that of the Child, I shall defend, indemnify, and hold harmless NAAF and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees, the costs of enforcing any right to indemnification under this Release, and the cost of pursuing any insurance providers, incurred by/awarded against NAAF or any other Releasees in a final judgment, arising out of or resulting from any claim related to my Child’s participation in the Teen Advocacy Fellow program, including any claim related to my Child’s own negligence or the ordinary negligence of NAAF.
5. I acknowledge and agree that if my Child need emergency medical care, I grant NAAF and its volunteers or agents the authority to obtain immediate medical attention for my Child and consent to whatever x-ray, examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed by or under the supervision of the medical staff of the hospital or facility furnishing medical or dental services. Accordingly, I acknowledge responsibility for my own medical insurance coverage and medical payments. NAAF WILL NOT PROVIDE MEDICAL, INJURY, OR ACCIDENT INSURANCE COVERAGE ON MY CHILD’S BEHALF.
6. I have read, understand and fully agree to the terms of this Release. I have signed this Release form freely, voluntarily, knowingly, under no duress, without inducement, promise or guarantee communicated to me not contained herein. My signature is proof of my intention to execute my consent on behalf of my Child in participating as a Teen Advocacy Fellow.
I acknowledge that I have carefully read this document and understand the information herein. I agree to each of the terms and acknowledgements herein and agree to consent to my child’s participation as a NAAF Teen Advocacy Fellow as described herein.