Participant Information
Parent / Guardian Information
Required for grades 3–11. Optional for 12th grade.
Interests
WAIVER / PHOTO RELEASE, AND INDEMNIFICATION AGREEMENT *
In consideration for being permitted to utilize the facilities, services, and programs of the YMCA of Paterson for any purpose, including but not limited to observation or use of facilities or equipment, or participation in any program affiliated with the YMCA of Paterson, without respect to location, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA of Paterson for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated programs have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use, or participation.
IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA OF PATERSON FOR ANY PURPOSE, INCLUDING BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH THE YMCA OF PATERSON, WITHOUT RESPECT TO LOCATION, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:
1) THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA OF PATERSON, its directors, officers, employees, and agents (hereinafter referred to as “releases”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releases or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein, or participating in any program affiliated with the YMCA of Paterson, without respect to location.
2) THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in, upon, or about the YMCA of Paterson premises or in any way observing or using any facilities or equipment of the YMCA of Paterson or participating in any program affiliated with the YMCA of Paterson whether caused by the negligence of the releases or otherwise.
3) THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to negligence of releases or otherwise while in, about, or upon the premises of the YMCA of Paterson and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA of Paterson.
THE UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the state of New Jersey and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I certify that I am or the parent or legal guardian of above named participant. I understand that this after-school program features special events both in-school and away from school. Media representatives, newspaper and television reporters, photographers, and public-relations personnel may be present at these special events to record them. In some cases, they may interview and/or photograph children who participate in these events. These photographs, videos, and interviews will only be used to promote this after-school program. I give permission for my child to be photographed or otherwise recorded during after-school events and activities, and for any and all such photographs to be displayed by [YMCA of Paterson] in any medium (books, newsletters, web sites, etc.), whether now or hereafter known or developed.