Waiver and Release of Liability and Publicity Consent Agreement
I, the undersigned, give permission for my Child to participate in CoderDojoAnvil’s 2015-2016 Program(“Program”) offered by CoderDojoAnvil at the Anvil, 320 North St, West Lafayette, IN, 47906. In consideration for my Child’s participation, I, on behalf of my Child, agree to the following:

1. I understand the Program consists of the following activities: Computer programming clubs for young people where they learn how to code, develop websites, apps, programs, games and more.

2. I understand that as part of my Child’s participation in the Program there are dangers, hazards, and inherent risks to which my Child may be exposed, including, but not limited to, the risk of serious physical injury, temporary or permanent disability, and death, as well as economic and property loss. I further understand that participating in the Program may involve other risks and dangers, whether known or unknown nor reasonably foreseeable.

3. I fully understand the scope of the activities and the risks involved. I voluntarily accept and assume all risks of injury, loss of life, or damage to property arising out of my Child’s participation in the Program.

4. I hereby release and fully discharge CoderDojoAnvil, including its officers, volunteers, employees, and agents, from any and all claims or causes of action, including all liability for damage to personal property or personal injury which may result from my Child’s participation in the Program, that may be brought by me or my Child or for any injury or loss that my Child may suffer while participating in the Event, whether caused by negligence or otherwise, to the fullest extent permitted by law.

5. I further release, indemnify, and hold harmless CoderDojoAnvil, including its officers, volunteers, employees,
and agents, from and against any and all liability, actions, debts, claims, and demands of every kind whatsoever,
including, but not limited to, any claim for negligence and/or any present or future claim, loss, or liability for which my Child
may be liable to any other person or to CoderDojoAnvil that arises out of my Child’s participation in the Program.

6. In the event of an accident or serious illness, I hereby authorize representatives of CoderDojoAnvil to obtain medical treatment and transport for my Child on my behalf. I waive my right to receive informed consent prior to such transportation or treatment. I hereby hold harmless and agree to indemnify CoderDojoAnvil from any claims, causes of action, damages and/or liabilities, arising out of or resulting from the medical treatment or transport. I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries to my Child that may occur during his/her participation in the Program.

7. This Agreement shall be governed by and construed under the laws of Indiana. Notwithstanding any other agreement that I have signed related to this Program that purports to establish the venue for any litigation arising from this Program, I agree that I will file no action against CoderDojoAnvil or its officers, volunteers, employees, and agents, whether based on this Agreement or in any way otherwise connected to this Program, in any court other than in Indiana.

8. Permission is hereby granted to CoderDojoAnvil to use quotations, photographs, films, video, made during the
activity(ies) of any participants for publicity purposes including, but not limited to, community awareness,
educational efforts, and other related initiatives. Further, it is hereby stipulated and agreed that CoderDojoAnvil will not
incur any liability for payment to any person or organization as a result of the stated use of the aforesaid quotations,
photographs, films, video, and/or voice recordings of the named individual.

9. I understand and agree to all of the terms of this Agreement. I understand that I am giving up substantial
rights (including my right to sue) and acknowledge that I am willingly signing this document. My signature on this
document is intended to bind not only myself and my Child, but also the successors, heirs, representatives,
administrators, and assigns of myself and my Child.
Email address *
Child's Full Name *
Parent/Guardians Full Name *
Parent/Guardians Signature (Print Name Below) *
Date *
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