Part 3 - YOUNG ADULT PARTICIPANT INFORMATION:
Please provide an alternate emergency contact in case neither parent can be reached
Emergency Release & Liability Waiver:
My son/daughter has my permission to attend Friendship Circle programs and events. I agree not to hold Friendship Circle liable for any accident, loss or theft that may occur during the course of a program or event. I hereby give my permission to the physician selected by the Friendship Circle to hospitalize, and/or secure necessary treatment or anesthesia for my child, as named above, in the event that I cannot be reached in an emergency. I hereby give my permission that paramedics may transport my child to the nearest hospital, if necessary. I have indicated any pertinent medical information above. I will not hold Friendship Circle liable for any accidents, injuries, damage or fatalities which may occur in transit to/from aforementioned events. I also waive all rights to sue Friendship Circle for any of the above mentioned incidents which may occur in transit. BY AGREEING TO THIS WAIVER, I/WE FREELY ACCEPT AND FULLY ASSUME RESPONSIBILITY FOR ALL SUCH DANGERS AND RISKS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM. IN CONSIDERATION OF UTILIZING THE RELEASEES’ FRIENDSHIP CIRCLE FACILITIES, I/WE HEREBY AGREE AS FOLLOWS:
1. TO WAIVE ANY AND ALL CLAIMS for personal injury including death, illness, property damage, and negligence that I/we may have against Releasees, their partners, principals, directors, officers, affiliates, agents, employees, contractors, representatives, members, all individuals and entities acting in concert with Releasees and any and all volunteers in any way associated with Releasees.
2. TO RELEASE THE RELEASEES FROM ANY AND ALL LIABILITY for any loss, damage, injury, death, medical or other expense that I/we may suffer or that any other party may suffer as a result of my use of Releasees’ facilities & other Releasees activities, due to any cause whatsoever.
3. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all loss, damages, costs, expenses, claims, liability and obligation for any property damage or personal injury to any third party resulting from my use of Releasees’ facilities and other Releasees activities, including but not limited to attorney fees and costs.
4. THIS RELEASE OF LIABILITY SHALL BE EFFECTIVE AND BINDING upon my heirs, next of kin, executors, administrators, successors, and assigns in the event of my personal injury including death, illness, and/or property damage.
I/WE HEREBY CERTIFY THAT I/we am covered by my own medical insurance, and that I/we have read and understand this Release of Liability prior to signing it, and I/we am aware that by signing this Release of Liability I/we am waiving certain legal rights which I/we or my heirs, next of kin, executors, administrators, successors, and assigns may have against the Releasees.
Releasees shall have the right to impose any additional conditions which, in the opinion of the Releasees, will further the intent and legal rights and waivers provided herein.
This liability waiver is made and executed in the State of New York and shall be governed by, enforced in and construed in accordance with the laws of the State of New York.
I/we acknowledge that in executing this waiver, I/we are not relying on any inducements, promises, or representations made by the Releasees.