Acknowledgement of Risk and Waiver of Liability
The Acknowledgement of Risk and Waiver of Liability (the "Release") executed on this day by the parent/legal guardian of "child" noted below, in favor of Abilities, Occupational Therapy, Physical Therapy, and Speech Language Pathology, PLLC and its successors, affiliates, directors, officers, employees, and agents (collectively "Abilities"). I freely and voluntarily execute this Release without duress under the following terms.
As the parent or legal guardian of Child:
  1. Waiver and Release I release and forever discharge and hold harmless Abilities and its successors and assigns from any and all liability claims and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from Child's participation in groups, classes, and/or other activities ("Activities") with Abilities, whether at its facility at 10 Mountain Ledge Drive, Wilton, NY 12831 (the "Facility") or elsewhere when my child is under the supervision of Abilities. I understand and acknowledge that this Release discharges Abilities from any liability or claims that I, as the parent or legal guardian of Child, and/or Child, may have against Abilities with respect of bodily injury, personal injury, illness, death, or property damage that may result from Child's participation in Activities with Abilities. It is also understood that Abilities does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury, illness, death, or property damage related to Child's time with Abilities. I expressly wave, on behalf of myself and Child, any claim of any kind for compensation or liability against Abilities.
  2. Medical Treatment I hereby release and forever discharge Abilities from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during Child's participation in Activities with Abilities.
  3. Assumption of Risk I acknowledge that Child's time with Abilities may include activities that could be hazardous to them including, but not limited to, collisions with other children, slips, trips, and falls. Bruises, contusions, strains, sprains, cuts, and other injuries may result. I expressly assume the risk of injury or harm in connection with Child's participation in activities with Abilities and release Abilities from all liability resulting from Child's time with Abilities. 
  4. Other I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of New York in the USA, and that this Release shall be governed by and interpreted in accordance with the laws of the State of New York. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
  5. Venue/Jurisdiction I agree that any action pertaining to this Release of the events/activities covered thereby shall only be brought in a court of competent jurisdiction in Saratoga County, New York. New York law shall apply, without regard to its conflicts of laws provisions.
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To express my understanding of this Release, I, as parent/legal guardian to above child, sign here.
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