, knowingly and voluntarily have chosen to voluntarily allow
, (participant’s name) to participate in individual and/or group services and
community-based activities and services offered through Slowfire LLC (hereafter referred to as the
“COMPANY”).
Services may also include activities in which the COMPANY and its staff, directors or agents are working alone with,
(participant’s name) as a passenger.
You further understand and acknowledge that these activities have risks, including certain risks which are inherent. Inherent risks are those which cannot be limited without destroying the unique character of these activities. You understand that all types of bodily injury are a risk when participating in these activities. You understand that the COMPANY assumes no responsibility or liability for your child’s participation in this activity, and you agree to assume all the risks of participating.
I,
(parent/guardian’s name) understand and voluntarily agree to release,
waive, and agree not to sue the COMPANY, or any staff, directors or agents under their charge, for any and all claims, damages, costs, attorney’s fees, or causes of action which I have or may in the future, as a result of damages or injuries relating to the participation or travel to and from activities with or inside the COMPANY building, except arising out of or incident to any negligent act or omission by the COMPANY.
I,
(parent/guardian’s name) understand and voluntarily agree to release,
harm associated with participating in activities and services offered through the COMPANY which may give rise to bodily injury. These risks include but are not limited to hazards associated with being a passenger in a vehicle and any other injuries that may result from driving activities. I further understand and agree that there may be risks and dangers not known or reasonably foreseeable at this time. I understand and agree that included within the scope of this waiver and release is any cause of action, arising from the failure to warn of existing dangerous conditions not known to or reasonably discovered by the COMPANY, or any staff, directors or agents under their charge.
I knowingly voluntarily assume full responsibly for these risks arising out of or related to,
(participant’s name) participating in activities and services offered through the COMPANY.
It is my express intent that this waiver and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE, the above named RELEASEES. I hereby further agree that this waiver of liability and hold harmless agreement shall be construed in accordance with the laws of the State of Illinois and that any mediation, suit, or other proceeding must be filed or entered only in Illinois and the federal or state courts of Illinois. Any portion of this document deemed unlawful or unenforceable is severable and shall be stricken without any effect on the enforceability of the remaining provisions.
The undersigned further consents to the administration of first aid and/or doctor’s care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the event of the necessity of such care or treatment as heretofore described, the undersigned agrees to hold harmless and indemnify the COMPANY, its directors, employees or agents and any such Agency, its directors, employees and agents from any acts of malfeasance, and/or failure to act or be part of those choosing to administer medical care on behalf of the participant.
I have carefully read, and I understand, acknowledge and agree to this release and waiver of liability, assumption of risk, and indemnity agreement. I understand that I have given up valuable rights by signing this agreement, and that this agreement represents a contract between the COMPANY and myself. I have voluntarily chosen to allow my child to participate in the COMPANY’S services and activities.
