Please read the following and complete the form below indicating your consent:
Mind Bubble – Volunteer Consent, Waiver, and Release of Liability Agreement
1. Mind Bubble’s Mission. I understand that Mind Bubble, Inc. (“Mind Bubble”) works to connect students at the secondary level with community members to provide free educational workshops, games, and 1-on-1 tutoring. I further understand that Mind Bubble is an inclusive community that is committed to respecting students for being themselves.
2. Mind Bubble’s Programs. I understand that Mind Bubble offers periodic educational workshops, which are presented by educators and other community members. I understand that these workshops are presented by volunteers, such as myself, who develop their workshops based on their personal knowledge of a subject-matter area. I understand that Mind Bubble also offers 1-on-1 tutoring with Mind Bubble volunteers, such as myself. I understand that in connection with 1-on-1 tutoring, Mind Bubble also facilitates opportunities for students to play games, including but not limited to board games, card games, strategy games, fantasy games, and story-telling games. I understand that the workshops, tutoring, and games constitute Mind Bubble’s Programs, and that Mind Bubble’s Programs are offered at various locations who have donated the use of the premises for Mind Bubble’s Programs.
3. Participation in Mind Bubble’s Program. I hereby acknowledge that I have agreed to participate in Mind Bubble’s Programs in a volunteer capacity.
4. Assumption of Risk. I understand and acknowledge that participation in Mind Bubble’s Programs carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries, including preparations for and transportation to and from Mind Bubble’s Programs, on my own behalf or as Mind Bubble may facilitate from time-to-time. I understand that the specific risks associated with Mind Bubble’s Programs vary, and include but are not limited to illness, emotional injury, and personal injury, including death, due to the physical, mental, and emotional challenges in Mind Bubble’s Programs. I understand and acknowledge that such outcomes or injuries may arise from my own or another’s action, inaction, or negligence, or conditions related to travel or the locations of Mind Bubble’s Programs. I understand that Mind Bubble does not make any representations as to the safety of the premises at which Mind Bubble’s Programs are offered. I hereby assert that my participation in Mind Bubble’s Programs is voluntary and that I knowingly accept and assume any and all associated risks, both known and unknown to me.
5. Hold Harmless. In consideration of my participation in Mind Bubble’s Programs in any capacity, I hereby agree to release, waive, discharge, and indemnify and hold harmless, to the fullest extent permissible under the law, Mind Bubble and its members, officers, directors, employees, contractors, volunteers, interns, facilitators, representatives, successors, assigns, and agents (the “Indemnified Parties”) from and against any and all actions, claims or losses, whether known or unknown, anticipated or unanticipated, that might arise out of or in connection with the administration of Mind Bubble’s Programs or any services provided or performed by any of the Indemnified Parties in connection with Mind Bubble’s Programs (“Claims”), whether such Claims are based on negligence, strict liability, breach of warranty, contract, or any other grounds. In addition, I fully, completely, and unconditionally waive and release each of the Indemnified Parties from all rights, liabilities, duties, claims, charges, demands, actions, damages, costs, attorney fees, or expenses of any kind that I may have now or in the future against any of the Indemnified Parties relating to my participation in Mind Bubble’s Programs.
6. Compliance with Mind Bubble’s Rules and Applicable Laws. I understand that I must abide by the instructions, policies, procedures, and regulations of Mind Bubble, including those conveyed by its members, officers, directors, employees, contractors, other volunteers, interns, facilitators, representatives, successors, assigns, and agents, as provided to me in writing or orally at any time. I also understand that I must abide by any applicable rules, regulations, or statutes otherwise prescribed by law while participating in Mind Bubble’s Programs. I understand that any violation of such instructions, policies, procedures, regulations, rules, or statutes may result in the suspension or termination of my participation in Mind Bubble’s Programs.
7. Privacy and Confidentiality. I understand that I will be expected to keep private and confidential any private and confidential information disclosed to or observed by me during my participation in Mind Bubble’s Programs, including information pertaining to the student participants in Mind Bubble’s Programs, information pertaining to Mind Bubble’s Programs, and information pertaining to the volunteers and staff of Mind Bubble. I understand that my failure or inability to abide by such confidentiality requirements may result in suspension or termination of my participation in Mind Bubble’s Programs.
8. Severability. In the event that any portion of this agreement, or any portion of any covenant, waiver, release, or indemnification hereunder, is held to be invalid or unenforceable, the validity or enforceability of the remainder of this agreement shall be unaffected and shall remain valid and enforceable to the fullest extent permitted by law.
9. Governing Law. This agreement and any disputes arising under or in connection with it shall be governed by the laws of the State of Georgia, excluding that State’s choice-of-law principles. I hereby consent to the exclusive jurisdiction and venue of the state and federal courts of Georgia.
Photo / Video / Media Release (OPTIONAL)
a. I hereby authorize each of the Indemnified Parties to make or capture images, take photographs, and make video and/or audio recordings of me in connection with my participation in Mind Bubble’s Programs. I understand and agree that Mind Bubble will own any such images, photographs, and recordings and that Mind Bubble shall have the right, in its sole discretion, to: (i) copyright any such images, photographs, and recordings in its own name or otherwise; (ii) use, reuse, publish, re-publish, perform, display, and distribute any such images, photographs, and recordings in whole or in part, in conjunction with any printed matter and any other media now or hereafter known, for illustration, promotion, art, advertising, and trade, or any other purpose, including through any media outlet or social media service; and (iii) use my name and any statement made by me in connection with any such images, photographs, and recordings, if Mind Bubble so chooses.
b. I am aware that I may be asked during my participation in Mind Bubble’s Programs a variety of questions concerning Mind Bubble’s Programs and that my statements and the contents of any images, photographs, and recordings of me may be published, including through any media outlet or social media service. I hereby reserve the right to refuse to answer any questions or participate in any discussion at any time I express to Mind Bubble a desire not to answer a question or participate in a discussion.
c. I understand that Mind Bubble has no obligation to air or publish any image, photograph, or recording of me. I also understand and agree that I will not receive any monetary compensation in exchange for any use by Mind Bubble of any image, photograph, or recording of me. I further understand and agree that my appearance or the use of my voice or statements in any image, photograph, or recording (including any televised or published form) does not confer any ownership rights on me. If by reason of my statements or actions in any interview, image, photo, recording, or any material furnished by me for the same, there is any claim or litigation involving any charge by third parties of violation or infringement of my right, I agree to indemnify and hold harmless the Indemnified Parties from any and all Claims arising therefrom.
Volunteer's full name
Volunteer's date of birth
I have read and understood this agreement. I hereby consent to this agreement and agree, on behalf of myself, and each of my respective personal representatives, guardians, successors, assigns, heirs, and next of kin, to be bound by its terms. I understand that this release, waiver of liability, and covenant not to sue shall remain effective even if I terminate my participation in Mind Bubble’s Programs and shall not expire at any time. (Typing your name constitutes your signature)
I give permission to use my likeness in either photographic or videotaped promotional materials. (Typing your initials constitutes your signature)
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