WILLIAM GROSE CENTER FOR CULTURAL INNOVATION
WGC Program Consent and Waiver Form
I, the undersigned participant or parent/guardian of the participant named above, hereby acknowledge and agree to the following terms and conditions for participation in the WGC program:
Assumption of Risk
I understand and acknowledge that participating in the program may involve certain risks and hazards, including but not limited to physical activities, use of equipment, outdoor elements, and transportation to and from the program. I voluntarily assume all such risks and hazards associated with participation in this program.
Medical Fitness
I confirm that the participant is physically and mentally capable of participating in the program. I understand it is my responsibility to inform program organizers of any pre-existing medical conditions, allergies, disabilities, or other relevant health information that may affect the participant’s safety or participation.
Release of Liability
I, on behalf of myself and the participant, release and discharge the William Grose Center, Africatown Community Land Trust, and their employees, agents, volunteers, and representatives from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, injury, or illness that may occur during participation, regardless of whether such loss, damage, injury, or illness is caused by negligence or otherwise.
Indemnification
I agree to indemnify and hold harmless the William Grose Center, Africatown Community Land Trust, and their employees, agents, volunteers, and representatives from any and all claims, demands, actions, causes of action, attorney's fees, and costs arising out of or related to the participant's participation in the program.
Photographic and Media Release
I grant permission to the William Grose Center to photograph, audio record, or video record the participant during the program. I understand these materials may be used for promotional, educational, and research purposes without further consent or compensation. I understand that the participant’s personal identity will not be publicly disclosed without prior consent.
Stipend Eligibility
To be eligible for the $50 stipend, participants must meet the following requirements:
Full Attendance: Attend all four days of the program.
Active Participation: Actively engage in sessions and complete any assigned activities or projects.
Communication: Notify the program coordinator of any unavoidable absences in advance.
The stipend will be disbursed in the form of a gift card after successful completion of the program.
Code of Conduct
By participating, I agree to adhere to the community guidelines and expectations set by the William Grose Center. Failure to comply may result in removal from the program and loss of stipend eligibility.
Acknowledgment
I have read and understand the above information. I acknowledge and agree to these terms and conditions as a requirement for participation in the WGC program.