Emerald Heart Release & Waiver of Liability
I, [NAME BELOW], agree to the following:
RELEASE AND WAIVER OF LIABILITY FOR TAIRA RESTAR OTTER DBA EMERALD HEART, outdoor locations, Marin County, CA.
By joining this group or attending an Emerald Heart program activity, gathering or event—which take place in outdoor settings, I agree to accept all parts of this Release and Waiver.
Assumption of Risk
There are sometimes unknown individual risks and circumstances that can arise during Emerald Heart program that cannot be foreseen. I understand that my participation in Emerald Heart’s program, at any level, is to be taken at my own risk, with no liability on Taira Restar Otter and/or Emerald Heart’s part, recognizing that there is a chance that illness, injury or even death could result. Additionally, I acknowledge that I am using my own capacity and assessment of risk when it comes to making my own decisions for myself and my child(ren), and I am voluntarily making those decisions with the full awareness that there may be risk involved to me or my child(ren). By attending any in-person activity, gathering or event with this group, I expressly assume any risks, injuries or damages, known or unknown, which my child(ren) or I might incur as a result of participating in Emerald Heart program.
By participating in Emerald Heart program I am acknowledging that I am solely and personally responsible for my own preparedness, health, life, well-being, choices, actions and results at all times, and for those of my child(ren). I am responsible for researching Emerald Heart program in which I am voluntarily participating, knowing the area, and bringing the proper gear for myself and my child(ren) for all weather conditions. I understand that I am responsible for determining whether Emerald Heart program is at an appropriate level for my child(ren), and for participating based on solely my own judgment. I take full responsibility for having appropriate equipment and supplies for Emerald Heart program.
Emergency Medical Assistance
I consent to the application of first-aid or other emergency medical services to be applied to my child(ren), if needed, in connection with an health problem or emergency during Emerald Heart program, including calling 911 for an ambulance. I agree to hold Taira Restar Otter, Emerald Heart Facilitators and Emerald Heart program harmless as a result of any such injury or damage my child(ren) may suffer due to the application of treatment, medical services, or emergency medical care provided or offered to my child(ren).
I agree to waive liability of Emerald Heart program, Taira Restar Otter, Emerald Heart Facilitators or any other member of a Emerald Heart group, for any accidents, delays, injuries, mishaps, harm, loss, damage, death, lost profits, personal or business interruptions, misapplication of information, physical disease, mental disease, condition or issue, or otherwise, affiliated with Emerald Heart program or Taira Restar Otter or otherwise, even if I am expressly advised of the possibility of such damages or difficulties, whether caused by the fault of myself, Taira Restar Otter, the Facilitators, other attendees or other third parties. This release and waiver extends and applies to, and also covers and includes, all unknown, unforeseen, unanticipated and unsuspected injuries, damages, loss and liability. In no event will I hold Emerald Heart program, Taira Restar Otter, program Facilitators or any other member of a Emerald Heart group liable for any direct, indirect, special, incidental or consequential damages for any use or non-use of, or reliance on, the program.
Taira Restar Otter and Emerald Heart do not provide liability insurance for the protection of individuals who may participate in any of the events that take place with the Emerald Heart program. I hereby waive and release all rights and claims for damages against Taira Restar Otter, Emerald Heart and its officers, members and families personally for all injuries which may be sustained by me or any family member(s) while participating in the programs I attend. I understand the content of the program and the risks of personal injury herein. I further agree to indemnify and hold harmless Taira Restar Otter, Emerald Heart and each of its members from any claim for loss or damage or injury to myself or any member of my family arising from or in connection with any participation in the program.
Release of Claims
In consideration of being permitted to participate in Emerald Heart program, I knowingly, voluntarily and expressly waive any claim I may have against Emerald Heart, Taira Restar Otter, and Emerald Heart Facilitators for any injury or damages that my child(ren) or I may sustain as a result of participating in Emerald Heart program. I agree now that I hereafter forever release Emerald Heart, its Facilitators and Taira Restar Otter from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which I have ever had, now have or will have in the future against Emerald Heart, its Facilitators and Taira Restar Otter, arising from my past or future participation in, or otherwise with respect to, any acts or omissions or anything related to Emerald Heart program.
I authorize you to use the following information relating to me, my children and my family: My picture – including photographic and electronic (video) images. I hereby grant to you the right to use, publish, and reproduce, for all purposes pictures of me or my child(ren) in film or electronic (video) form, sound and video recordings of my or my child’s voice, and printed and electronic copy in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. I further grant you all right, title, ownership and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant you the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, advertising or for any other purpose, as it deems fit.
I acknowledge that I am participating voluntarily in Emerald Heart program with the full awareness that my participation may contain certain inherent risks to me or my child(ren), and I voluntarily consent to all such risks. I give full consent to participating in Emerald Heart program activities, gatherings and events, and by providing my consent, I voluntarily agree to all of the terms of this Release and Waiver. Regardless of whether I have provided my signature or not, my child(ren)’s attendance at Emerald Heart program signifies that I have read this Release and Waiver and I fully understand and implicitly consent to all of its contents.
Children bound under this agreement: [NAMES AND BIRTHDATES BELOW]
By entering my name below, I am effectively providing my signature, indicating that all the information on this form is true and accurate, to the best of my knowledge. [SIGNATURE BELOW]
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