RELEASE, INDEMNIFICATION AND WAIVER FORM:
I, the undersigned, hereby acknowledge that I have been advised and fully understand that certain elements of danger
are inherent in the activities sponsored by Hawthorn Farm, LLC which are beyond the control of the agents, students,
tenants, and employees of Hawthorn Farm, LLC, and that participation by myself or my family in any activities may
entail unavoidable risk of personal injury, death, and loss of or damage to property. These risks include, but are not
limited to, insect and animal bites and stings, forces of nature such as but not limited to lightning and extreme weather
conditions, use of hand tools and power tools, and any hazard present in the wilderness or suburban farm settings.
I hereby assume all risks of injury and death to my child and loss of or damage to property arising out of my child’s
participation in such activity and I agree to indemnify, hold harmless Alexia Allen and Daniel Kirchhof and any tenants
and employees there-of or Hawthorn Farm, LLC (“Releasees”) from and against all claims arising from any occurrence
causing damage or injury to myself, my child(ren) or to any party participating in said event or any third parties injured
as a result of my child’s actions. I also confirm that by signing as a Parent/Guardian, I release, waive, and discharge
the Releasees for all claims any parent of my child(ren) might have as a parent or guardian for injury to any child for
whom I have signed. I further agree to repair or reimburse Hawthorn Farm LLC or Alexia Allen for any and all
damages that my child(ren) or family causes to the property at 17340 NE 195th St, Woodinville WA 98072 or wherever
the specific program may be held.
In the event that my child requires medical attention while participating in this program, I hereby grant permission to
Hawthorn Farm, LLC and its representatives to provide for the rendering of such care, including diagnostic procedures,
surgical and medical treatment, by authorized medical staff or their designees, as may in their professional judgment
be necessary. I hereby acknowledge that I am responsible for all reasonable expenses in connection with care and
treatment rendered during this period.
I grant permission for Alexia Allen, Daniel Kirchhof and Hawthorn Farm to use images and photos of myself or my
children for promotion of Hawthorn Farm website, programs or newsletters.
Prior to signing below, I have read and understood the terms and conditions of this Release, Indemnification, and
Waiver, understand by signing below I am waiving certain legal rights I may have against the Releasees, and I agree
to subscribe to all the terms and conditions set out above.