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2 - Children Information
3 - Parent Information
4 - Emergency Contact Information
Consent and Waiver - Terms and Conditions
I, the undersigned, as the undersigned or as the parent or legal guardian of the minor child (“my child”) named above, do hereby give my full consent and approval for my child to participate as a member of EPIC’s Learning Programs.
I, hereby, release EPIC administration, its agents, affiliates, partners, teachers, and volunteers of all liabilities of any possible injury to my child(ren) on or off the Masjid premises.
Further, I agree that in consideration for my or my child’s participation in EPIC’s Learning Programs, I hereby waive, release, discharge and agree not to sue EPIC, its committees, employees, officials, coaches, volunteers and agents (“Released Parties”), for any and all causes of actions, claims or damages arising out of or resulting from my or my child’s participation in this activity, including but not limited to damages and injuries arising out of the negligence of Released Parties or otherwise. I agree that for me or my child to participate in the activity, I assume full responsibility for any loss of property, accident, and bodily injury as a result of my or my child’s participation in this activity.
I hereby permit EPIC to use or distribute any or all still and/or moving images in which I/my child/my ward appear for any use including, but not limited to: video, Web, print and multimedia applications; training or other instructional materials; advertising, commercials or other promotional materials; and other forms of media, without compensation. Any image (s) created shall be the property of EPIC.
I hereby give permission for me or my child/ward to receive necessary medical treatment. I further agree on behalf of myself and my child listed below, that I shall hold harmless and fully indemnify and defend the Released Parties from any and all causes of action, claims, damages, costs including but not limited to attorney’s fees and costs, which may arise from any cause of action made by me or by, through or on behalf of me or my child, even if the damages, injuries are caused in whole or in part by the negligence of the Released Parties.
I acknowledge (a) that I have read (or have had read to me) each and every one of the provisions in this waiver, release of liability and indemnification agreement, (b) that I understand each of the provisions in this agreement and (c) that I agree to abide by them.