RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

                                                                            

I, on behalf of my minor child ____________________________ (“Participant”), hereby acknowledge that Participant has voluntarily elected to enroll in the 2019 Lumos Debate April or Summer session ("Program”), I hereby acknowledge and agree to the following:

                                                                            

ELECTIVE PARTICIPATION: I acknowledge that my participation (or my enrollment of my minor child) is elective and voluntary. As a condition of my participation, I hereby grant to Breakaway Team LLC the right to use, for promotional purposes only, any photographs of me taken by Breakaway Team LLC, its employees or agents, during my participation in the Program. I further understand and agree Breakaway Team LLC may use (for marketing purposes) any statements or quotes attributed to me in my evaluation of the Program.

                                                                            

INFORMED CONSENT: I have been informed of and I understand the various aspects of the Program. I understand and agree that I/my minor child will engage in activities which may pose a risk of harm. I understand that these activities include but are not limited to: playing, observing or participating in Program activities, and/or traveling to and from Program events. I further understand and agree that the risks involved in this Program may include, but are not limited to: injury resulting from game-like activities during the Program as a result of the activity area’s conditions, the acts of third parties or other unknown safety hazards, first aid operations or procedures of Releasees and/or others, and that there may be other risks not known to me or not reasonably foreseeable at this time. By participating, I/my minor child could sustain serious personal injuries, illness, property damage, or death as a consequence of not only Breakaway Team LLC’s actions or inactions but also the actions, inactions, negligence or fault of others, the conditions of equipment used, facility conditions, weather conditions, negligent first aid operations and procedures, and I understand that there may be other risks not known to me or not reasonably foreseeable at this time. I further understand and agree that any injury, illness, property damage, disability or death that I/my minor child may sustain by any means in connection with my/my minor child’s participation in the Program is my sole responsibility, except for those occurrences that are caused by gross negligence or intentional acts on the part of Breakaway Team LLC.

RELEASE AND WAIVER OF LIABILITY: I, on behalf of myself/my minor child, my/my minor child’s personal representatives, heirs, executors, administrators, agents, and assigns, HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Breakaway Team LLC its directors, employees, agents, volunteers and any students (hereinafter referred to as "Releasees") for any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys' fees), arising from any injury, property damage or death that I/my minor child may suffer as a result of my/my minor child’s participation in the Program, UNLESS THE INJURY DAMAGE OR DEATH IS CAUSED BY THE RELEASEES’ GROSS NEGLIGENCE OR INTENTIONAL ACTS. I further agree that the Releasees are not in any way responsible for any injury or damage that I/my minor child sustain as a result of my and/or my minor child’s own negligent and/or intentional acts. I understand that this release and waiver is intended to be as broad and inclusive as permitted by the laws of the Commonwealth of Massachusetts and agree that if any portion of this release and waiver is held invalid, the remainder of the shall continue in full legal force and effect.

ASSUMPTION OF RISK: I understand that there are potential dangers incidental to my/my minor child’s participation in the Program because the Program includes activities, some of which may be dangerous and which may expose me/my minor child to the risk of personal injuries, property damage, or even death. I understand that these potential risks include, but are not limited to: injury resulting from game-like activities during the Program as a result of the activity area’s conditions, the acts of third parties or other unknown safety hazards, first aid operations or procedures of Releasees and/or others, and that there may be other risks not known to me or not reasonably foreseeable at this time. I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE ACTS IF THE RELEASEES, UNLESS THEY ARISE FROM THE RELEASEES’ INTENTIONAL OR GROSSLY NEGLIGENT ACTS, and assume full responsibility for my/my minor child’s participation in the Program.

                                                                            

INDEMNITY: I, on behalf of myself, my personal representatives, heirs, executors, administrators, agents, and assigns, agree to hold harmless, defend and indemnify the Releasees from any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys' fees), arising from any injury, property damage or death that I/my minor child may suffer as a result of my/my minor child’s participation in the Program, UNLESS THE INJURY DAMAGE OR DEATH IS CAUSED BY THE RELEASEES’ GROSS NEGLIGENCE OR INTENTIONAL ACTS.

                                                                            

PERSONAL MEDICAL INSURANCE. I agree to purchase and maintain during the term of the Program personal medical insurance for myself/my minor child. I further acknowledge that I am responsible for the cost of any and all medical and health services I/my minor child may require as a result of participating in the Program.

                                                                            

CERTIFICATION OF FITNESS TO PARTICIPATE: I attest that I/my minor child am/is physically and mentally fit to participate in the Program and that I/my minor child do not have any medical record of history that could be aggravated by my/my minor child’s participation in the Program.

                                                                            

MEDICAL CONSENT: I understand and agree that Releasees may not have medical personnel available at the location of the Program or off-site Program event. In the event of any medical emergency, I authorize and consent to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care that Breakaway Team LLC personnel deem necessary for my/my minor child’s safety and protection. I understand and agree that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.

                                                                            

CHOICE OF LAW: I hereby agree that this Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts.

                                                                            

OPTIONAL: I understand that I may seek legal counsel of my own choosing to fully explain any terms of this Agreement to me before I sign it.

                                                                            

SEVERABILITY: If any term or provision of this Agreement shall be held illegal, unenforceable, or in conflict with any law governing this Agreement the validity of the remaining portions shall not be affected thereby.

                                                                            

I hereby acknowledge that I have read, understand and will abide by each of the terms and conditions of this Agreement. My child, the Participant, has also read, understands, and will abide by the terms and conditions of this Agreement.  

                                                                     

Signature of Parent/Guardian for Participants Who Are Minors:                                                                            

I certify that I a parent of Participant or am the legal guardian of Participant by court order. I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND AND AGREE TO ITS TERMS. I AM AWARE THAT THIS AGREEMENT INCLUDES A RELEASE AND WAIVER OF LIABILITY, AN ASSUMPTION OF RISK, AND AN AGREEMENT TO INDEMNIFY BREAKAWAY TEAM LLC.

                                                                            

__________________________________________ (Signature of Parent or Guardian)

                                                                            

__________________________________________ (Printed Name of Parent or Guardian)                                                                  

Date: ________________________