Community Pinwheel Walk to Prevent Child Abuse
Injury Release/Waiver - Photo Release - Consent for Minor
***A signed waiver is required!***
Injury Release/Waiver:
I am aware that by participating in this activity, there is a chance I could suffer an injury from risks such as, but not limited to, falls, interaction with other participants, and the effects of weather, traffic, and road conditions. In consideration of the right to participate in this activity, I waive and release any and all rights and claims for damage that I may have against The Children’s Center of Medina County, its directors, employees, and/or volunteers, the City of Medina, The County of Medina and their representatives from any and all injuries suffered as a result of participation in the Community Pinwheel Walk. I am responsible for my own health and safety. I am in good health and able to participate in this activity. I agree to stop and request assistance if I experience any unusual symptoms. I give consent to emergency care, including hospitalization as may be needed and take full financial responsibility for such treatment.
I agree for myself, my heirs, executors, and administrators to not sue and to release, indemnify, and hold harmless, The Children's Center of Medina Country, its directors, employees, and/or volunteers, and all sponsoring businesses and organizations and their employees from any and all liability, claims, demands, and causes of action whatsoever, arising out of my participation in this event and related activities whether it results from the negligence of any of the above or from any other cause. This release and indemnification agreement shall be as broad and inclusive as permitted by the state in which the event is conducted. If any portion of it is invalid, the balance shall continue in full force and effect.
Photo Release:
I hereby authorize The Children’s Center of Medina County to use my likeness in photograph(s)/video or promotional advertisements in any and all of its publications and in any and all other media for the purpose of publicizing The Children’s Center of Medina County’s programs or for any other lawful purpose. I will make no monetary or other claim against The Children’s Center of Medina County for the use of the photograph(s)/video or promotional advertisement. I hereby grant The Children’s Center of Medina County permission to use my likeness in photograph(s)/video or promotional advertisement.
Consent for Minor:
If the person registering is under age 18, there must be consent by a parent or guardian as follows: I hereby certify that I am the parent or guardian of above named child, and do hereby give my consent for his/her image to be captured and used, and do hereby release The Children’s Center of Medina County, its directors, employees, and or volunteers from any claims for damages of any kind if said minor is injured as a result of participating in walk activities.
Acknowledgement:
I am age 18 or older, or the guardian of a minor, and do hereby give my consent as outlined above. I verify that I have read and agreed to the event waiver, thus in no way hold The Children's Center of Medina County, its directors, employees, and/or volunteers, or any other event affiliates responsible.
I have read, understand, and agree to the terms of this agreement and signed of my own free will even though I understand it is a requirement for participation in the
Community Pinwheel Walk.
I acknowledge that I have been provided a copy of the WAIVER for Injury Release, Photo Release & Consent for Minor. I have read and understand its entirety which I (or by parent/guardian if under 18 years) agree to its terms. This release and waiver may be executed by electronic signature, which shall be deemed original and binding on the signer.
