Kaya Health Cooking Class Waiver
  • Form

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  • LIABILITY WAIVER AND RELEASE FORM / MINOR CHILD

  • THIS IS A RELEASE OF LEGAL RIGHTS READ AND UNDERSTAND BEFORE SIGNING

    In exchange for participation in the activity of cooking classes organized by Kaya Health LLC (“Kaya Health”) and/or use of the property, facilities and services of Erika Mobine, located at 1647 El Verano Drive, Thousand Oaks, CA 91362 (“The Subject Property”). I agree, as parent or legal guardian of     *   *   , a minor child (“the Minor Child”) under the age of eighteen, to the following:

  • 1.    CONSENT. I,*   *  , consent to the participation of my son/daughter,* * , in cooking classes, and agree on behalf of the above-referenced Minor Child to all of the terms and conditions of this Agreement. By signing this Release of Liability, I represent that I have legal authority over and custody of*   * .

    2.    ASSUMPTION OF THE RISKS AND RELEASE. I understand and acknowledge, and am fully aware of the certain inherent risks associated with the above described activities. I am aware that the cooking classes will be held in a real kitchen, using a range with open flames. Various household appliances, an oven, peelers, graters, can openers, and certain sharp objects. Children may be on step stools and using hot water. I hereby assume the risks including, but not limited to, bodily injury to the above-named Minor Child, property loss, or other damage incurred in connection with said Minor Child’s participation in said activities. I acknowledge my responsibility to ensure that said Minor Child cooperates fully with all of Kaya Health’s rules and safety procedures. I assume full responsibility for personal injury to said Minor Child, and further release and discharge Kaya Health, Erika Mobine, and any other individual with any interest in Kaya Health, or The Subject Property, for injury, loss or damage arising out of the Minor Child’s participation use of or presence upon the facilities of Kaya Health, whether caused by the fault of the Minor Child, Kaya Health, or any third party.

    3.    INDEMNIFICATION. To the fullest extent allowed by law, I agree to indemnify and hold harmless Kaya Health, Erika Mobine, any officers, directors, staff, volunteers, employees and agents, from and against any present or future claim, cause of action, loss, damages, judgments, costs or expenses, including attorney fees and other litigation costs, or liability, for injury to person or property, which said Minor Child may suffer, or for which said Minor Child may be responsible, to any person, related to said Minor Child’s participation in the activities, or acts or omissions on The Subject Property, regardless of the cause and regardless of fault.

    4.    DAMAGES. I agree to pay for all damages to the facilities of Kaya Health and Erika Mobine caused by any negligent, reckless, or willful actions of said Minor Child.

    5.    FOOD ALLERGIES/RESPONSIBILITY. Kaya Health will make all reasonable efforts to accommodate food allergies, and religious and cultural practices. The kitchen that will be used for the cooking activities is not nut free. I assume responsibility to disclose any allergy/and/or religious or cultural practices to Kaya Health, at least seventy two (72) hours prior to class. I am responsible for bringing any medications or relevant medical tools to aid in the event of an allergic reaction.

    6.    MEDICAL AUTHORIZATION. In the event of an injury to the above Minor Child during the above described activities, I give my permission to Kaya Health or to the employees, representatives or agents of Kaya Health to arrange for all necessary medical treatment for which I shall be financially responsible. This temporary authority will begin on ­­­­­­­­­­­­­­   Pick a Date*   and will remain in effect until terminated in writing by the undersigned or in one (1) calendar year. Kaya Health shall have the following powers:

    a. The power to seek appropriate medical treatment or attention on behalf of the above-referenced Minor Child as may be required by the circumstances, including without limitation, that of a licensed medical physician and/or a hospital;
    b. The power to authorize medical treatment or medical procedures in an emergency situation; and
    c. The power to make appropriate decisions regarding clothing, bodily nourishment and shelter.

    7.    APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the above shall be resolved under California law.

    8.    NO DURESS.I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire. I further agree and acknowledge that Kaya Health has offered to refund any fees I have paid to use its facilities if I choose not to sign this Agreement.

    9.    ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement.

    10.    DISPUTE RESOLUTION. The Parties will attempt to resolve any dispute arising out of or relating to this Agreement through informal negotiations between the Parties. If the matter is not resolved by negotiation, the parties will resolve the dispute using the below Alternative Dispute Resolution (ADR) procedure.

    Any controversies or disputes arising out of or relating to this Agreement will be submitted to mediation in accordance with any statutory rules of mediation. If mediation is not successful in resolving the entire dispute or is unavailable, any outstanding issues will be submitted to final and binding arbitration, to the American Arbitration Association, or any other arbitration service agreed upon by the Parties, under the rules of the American Arbitration Association or such other service, whichever is utilized. The arbitrator's award will be final, and judgment may be entered upon it by any court having proper jurisdiction.

    11.    EMERGENCY CONTACT. In case of an emergency, please contact:         *   *   .

    I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

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    Pick a Date*   

  • MEDIA RELEASE FORM

  • I, the undersigned, grant to "Erika Mobine/Kaya Health " and its designees, affiliated entities, licensees, successors and assigns (collectively, the “Licensed Parties”) a worldwide, perpetual right and license to use, reproduce, print, publish, broadcast and rebroadcast, as well as to copyright, my information, testimonial statement, voice, picture, name or likeness (my “Submission”) in any and all media and types of publication or advertising (“Materials”) to promote the Licensed Parties and their products and services.

    All right, title, and interest in and to my Submission used in Materials pursuant to this Release, including all copyrights therein, will be the sole property of the Licensed Parties, free from any claims whatsoever.

    I understand that I will not have any right to compensation in connection with the Licensed Parties’ use of my Submission. I hereby release the Licensed Parties and their successors and assigns from any and all claims arising out of their use of my Submission as described in this Release, including without limitation any claims based on libel, slander, or the rights of publicity, privacy or personality. I hereby waive any right to review any Materials and agree that no Materials need be submitted to me for any further approval.

    I acknowledge that this permission authorizes the Licensed Parties to post Materials that include my Submission on third party social media web sites (including Facebook, Twitter, Instagram, and YouTube), which may require Licensed Parties to grant the owners and users of such sites a broad license to use the Materials for any purpose without notice to or approval from me.

    Any statements attributed to me in my Submission reflect my actual experience with the Licensed Parties and my honest opinions about the Licensed Parties and/or their products and services. I understand that I have the right to revoke this Release by delivering written revocation to a “Erika Mobine/Kaya Health " or other authorized individual for the Licensed Parties; provided however that this will not impose any obligation upon the Licensed Parties to recall or destroy any Materials already used, published or disclosed. This Release does not in any way conflict with any existing commitment on my part. I understand that this Release does not obligate the Licensed Parties to make any use of my Submission or any of the rights granted herein.

    If my Submission relates to a minor child, I am a parent or legally appointed guardian of such minor, and I have the right to contract for the minor with respect to this Release.

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    Pick a Date*   

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