Pasefika Roots Institute of Language and Cultural Arts
Liability Waiver, Release of Liability, and Media Consent Agreement
PROGRAM: Cycle 3 – Fa’aSamoa Village Life Summer Camp (June 1st - June 6th, 2026)
ACTIVITY: Fa'asamoa Village Life Summer Camp
By submitting your registration, enrollment, or entry form for the Pasefika Roots Institute of Language and Cultural Arts (“PRILCA”) programs, you (the “Participant” or “Parent/Guardian” of a minor Participant) acknowledge and agree to the following terms:
1. Attendance & Chaperone Requirements
I agree to ensure my child arrives on time at 11:00 AM and is picked up promptly at 2:00 PM daily. I explicitly acknowledge that for any child registered under the age of 6, a parent or designated legal guardian must remain present in the hall at all times. The Pasefika Roots Institute is not a licensed childcare facility and cannot assume solo custody of children ages 5 and under.
2. Voluntary Participation and Assumption of Risk
I understand that participation in the Fa'asamoa Village Life Summer Camp (June 1st - June 6th, 2026) may involve physical activity, the use of various tools/materials, and interaction with others. I voluntarily assume all risks associated with participation, including but not limited to, physical injury, illness, or property damage. I acknowledge that these risks may arise from my own actions, the actions of others, or the condition of the facilities and equipment.
3. Release of Liability and Indemnification
I hereby release, waive, discharge, and covenant not to sue the Pasefika Roots Institute of Language and Cultural Arts, its directors, officers, employees, volunteers, agents, independent contractors, partners, and sponsors (collectively, the “Released Parties”), as well as the owners and operators of the hosting facilities where workshops are conducted, from any and all liability, claims, demands, or causes of action whatsoever arising out of or related to any loss, damage, or injury that may be sustained by the Participant while participating in the program.
4. Third-Party and Hosting Facility Waiver
I understand that PRILCA often partners with external organizations and utilizes third-party hosting facilities. I agree that this waiver extends to all partner organizations, school districts, community centers, and private venues associated with the Fa’aSamoa Program. These entities shall not be held liable for any injuries or damages occurring on their premises during the course of the workshops.
5. Media and Likeness Release
I hereby grant PRILCA and its legal representatives the irrevocable right and permission to use, publish, and distribute photographs, video recordings, and audio recordings of the Participant taken during the workshops.
Purpose: These materials may be used for educational, promotional, marketing, or social media purposes to highlight the program’s impact.
Compensation: I waive any right to royalties or other compensation arising from or related to the use of such media.
Ownership: I agree that all such images and recordings are the property of PRILCA.
6. Medical Acknowledgment
I certify that the Participant is physically fit and has no medical condition that would prevent full participation in the workshops. In the event of a medical emergency, I authorize PRILCA staff to seek emergency medical treatment for the Participant if I am unavailable, and I agree to be responsible for any costs incurred.
7. Food & Allergy Disclaimer
I understand that a daily lunch and community snacks will be provided to registered participants. I agree to list all known food allergies, restrictions, or medical dietary needs on this form. I acknowledge that while staff will make reasonable efforts to monitor food distribution, the camp cannot guarantee an allergen-free environment, and I release the institute from liability related to accidental allergic exposure.
8. Code of Conduct & Cultural Protocol (Aganu'u)
I agree that all participants will abide by the core village values practiced during our sessions: Fa'aloalo (Respect to instructors, peers, and library staff), Tautua (Service and helping maintain a clean community environment), and Loto Fesoasoani (A cooperative, helpful spirit). The institute reserves the right to terminate a student's camp participation if behavioral boundaries are repeatedly violated.
9. Agreement by Submission
I acknowledge that this is a legally binding agreement. By submitting the registration or enrollment form for the Fa’aSamoa Program, I certify that I have read and understood this waiver in its entirety. If the Participant is under the age of 18, the submission of the form by a Parent or Legal Guardian constitutes consent on behalf of the minor.