On [DATE]  at [LOCATION], in conjunction with hosts and affiliated organizations which may use event images. During the program, we will take data, pictures and video of the participants, adult supervisors, staff, and student volunteers participating in the event. These photos are used within the program and in professional presentations, public relations, and marketing efforts on behalf of Explore the Magic of Motion® LLC, hosts, registered volunteers, and organizations affiliated with the event.

 

I give permission__________________________________

                                                                          (Print Name)

 

to be photographed or videotaped, and for the photos to be used in educational presentations (to healthcare professionals, families, patients, referral sources and payers, in the media (including newspapers, magazines, television, social media and radio), marketing presentation and publications such as brochures, annual reports, pamphlets, newsletters, or for any other purpose by or about Explore the Magic of Motion® LLC, certified hosts, registered volunteers and organizations affiliated with the event.

 

I understand that this permission is given in perpetuity, not limited by territory, and not limited to the known, material universe or to any specific medium. I also understand that there is no payment or any kind due to me as a result of these granted permissions. I understand that my image may be edited and stored in any medium now existing or yet to be invented, in the material or digital universe or any other universe not yet in existence, that I have no right of approval to any such edits or to the uses of my image or voice captured as a result of my participation in the event or any likeness thereof. I indemnify and hold harmless Explore the Magic of Motion® LLC, certified hosts, registered volunteers, and organizations affiliated with the event from any liability of the use of my image, voice, image likeness or voice likeness for any purpose.

 

to have data collected such as age, workshop scores and zip code, during the event may be used by third parties with the exception of personal identifying information such as my name and date of birth which will be removed prior to distribution.

​

I agree to be responsible for the conduct and actions of my child/children and/or myself and to release Explore the magic of Motion, host and organizations affiliated with the event from any claims and demands that may occur during participation in Explore the Magic of Motion® programs held in-person or virtually on the aforementioned date and time. Furthermore, I agree to indemnify, hold harmless, and release Explore the Magic of Motion® LLC, host, and organizations affiliated with the event from any liability which may arise from incidents or accidents involving my child/children and myself during an event, to the extent allowed by law. I further acknowledge that my children remain in my custody during the entire event and at no time will Explore the Magic of Motion, LLC, its representatives, or anyone else associated with the event take custody of or be responsible for the safety or actions of my children.

 

______ (Initials Required) I have reviewed the COVID-19 Waiver.

Assumption of the Risk and Waiver of Liability Relating to COVID-19

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that myself or my child(ren) may be exposed to or infected by COVID-19 by

 

attending an Explore the Magic of Motion LLC (“Business”) event and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Business may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Business employees, agents, independent contractors, affiliates, successors, and assigns (Collectively the “Released Parties.”)

 

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself or my child(ren) (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my attendance at the Business (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Business, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Business, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after visiting the Business. I agree to indemnify, defend, and hold harmless the Released Parties from and against any and all costs, expenses, damages, claims, lawsuits, judgments, losses, and/or liabilities (including attorney fees) arising either directly or indirectly from or related to any and all claims made by or against any of the Released Parties due to bodily injury, death, loss of use, monetary loss, or any other injury from or related to my use of the Business, tools, equipment, or materials, whether caused by the negligence of the Released Parties or otherwise specifically related to COVID-19.

 

By signing below I acknowledge and represent that I have read the foregoing Waiver of Liability, understand it and sign it voluntarily as my own free act and deed, including without limitation the Release of Liability and Indemnification requirements contained in this document; I am sufficiently informed about the risks involved in visiting the business to decide whether to sign this document; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this document for full, adequate, and complete consideration fully intending to be bound by the same. I agree that this Waiver of Liability shall be governed by and construed in accordance with [STATE] law, and that if any of the provisions hereof are found to be unenforceable, the remainder shall be enforced as fully as possible, and the unenforceable provision(s) shall be deemed modified to the limited extent required to permit enforcement of the Waiver of Liability as a whole.

 

_________________________________________                                 __________________

Child Signature                                                                                       Date

 

_________________________________________                                

Print Guardian/Responsible Party                                                            

 

_________________________________________                                 __________________

Guardian/Responsible Party Signature                                                         Date