Liability Release and Indemnification Agreement for Circle Participants
Name of Parent(s)/Guardian(s) *
Name of Child(ren) *
Address *
Telephone Number *
I, individually and as parent/guardian of any participating child(ren), hereby agree to forever release, hold harmless, defend and indemnify Parenting Village, Inc., their officers, directors, employees, agents, and volunteers for any loss, claims, liabilities, negligence, injuries or damages arising from or in any way related to the services offered to my family as a participant in Parenting Village’s Circles. I understand that Circles are facilitated drop-in meetings for parents where they can voice the joys and challenges of parenthood. The groups are non-clinical in nature. The groups are not intended to provide any legal guidance or advice. I understand that Circles are intended to offer peer support and do not diagnose, prescribe, or in any way treat medical or mental health concerns. You can, and should, seek the advice of appropriate professionals, whether medical, legal, mental health, or others, as needed. Parents are welcome to bring infants/toddlers to Circles. Toys are provided for children to play with under their parent/guardian’s supervision. Snacks may be provided as well. I acknowledge that I have read this document; fully understand the potential dangers inherent in participation in the programs; am aware of the legal consequences of signing this document; and, understand and agree that this document may preclude myself or my child from recovering monetary damages for any personal injury, property damage or wrongful death caused by the conduct, including but not limited to any alleged negligence, of Parenting Village, Inc., its officers, directors, employees, and agents. Further, I understand that Parenting Village, Inc. may utilize remote conferencing services (such as Zoom or other conferencing software) to conduct Circles. I understand that Parenting Village, Inc. will make all reasonable efforts to protect the confidentiality and sensitivity of its Circles and all the participants. I recognize that despite all reasonable efforts, complete confidentiality of Circles cannot be guaranteed. I have electronically executed this release on this date, 2020, by typing my full name herein and submitting this form. *
By clicking "I understand" below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *
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