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VIVITA USA, INC.  

LIABILITY WAIVER AND RELEASE AGREEMENT

I, on behalf of myself, my minor child(ren), my heirs, devisees, personal representatives, successors, and assigns (collectively, “Covered Parties”) enter into this Liability Waiver and Release Agreement (“Agreement”) with VIVITA USA, INC. (“VIVITA”), its owners, directors, officers, employees, agents, representatives, parents, affiliates and/or assigns (collectively “VIVITA Parties”). In consideration of allowing my minor child(ren)’s participation in VIVITA’s workshops and activities, I, on behalf of myself and the Covered Parties, hereby waive, release and forever discharge, covenant not to sue, and agree to indemnify and hold harmless the VIVITA Parties from any and all liabilities, claims, actions, damages, penalties, suits, costs, or expenses of any nature whatsoever, now or in the future (collectively, “Damages”), against the VIVITA Parties arising out of or in any way related, directly or indirectly, to my minor child(ren)’s participation in VIVITA’s workshops and activities, whether that participation is supervised or unsupervised, however the injury or damage occurs, to the extent permitted by law. This Agreement applies to any and all VIVITA workshops and activities that my child(ren) participates in. This Agreement includes but is not limited to all harm caused by and/or resulting from the failure of the Covered Parties to observe the standard of reasonable care imposed by the law of negligence. In addition to the above, I agree that I am fully responsible for the conduct of my minor child(ren) while using VIVITA’s facilities and/or equipment and any damage or injury my minor child(ren) may cause.  


I acknowledge the nature and extent of the risks associated with participation in VIVITA’s workshops and activities, including, but not limited to, the risk of personal injury, illness, exposure to or infection of the coronavirus COVID-19, property damage, and other losses. I, on behalf of myself and my minor child(ren), voluntarily participate in these activities and assume these risks and all other associated risks to myself or my minor child(ren) that may be sustained while participating in VIVITA’s workshops and activities. 


I further acknowledge and agree that unless otherwise agreed to by VIVITA, I will not be permitted to observe or accompany my minor child(ren) while s/he is participating in VIVITA’s workshops and activities. I acknowledge that my minor child(ren) are free to come and go during workshops and activities, that VIVITA will not monitor their presence in the VIVITA space, and that VIVITA shall not be liable for any Damages occurring offsite. 


In addition, I consent and give permission to VIVITA to take photographs and/or video of my minor child(ren) while participating in VIVITA’s workshops and activities, and consent to the publication of said photographs and/or video by VIVITA for any legal use, including use for publicity, social media, and web content. I understand that I have the right to withdraw this consent at any time by providing written notice to VIVITA.  


By signing this Agreement, I am certifying that: (1) I have read the above Agreement, understand it, and sign voluntarily and without any inducement; (2) I am at least eighteen (18) years of age and am of sound mind; and (3) I am the legal guardian of the minor child(ren) listed below and sign this Agreement on their behalf. I further certify that: (4) the minor child(ren) listed below is in good health and has no conditions or impairments which would preclude his/her safe participation in VIVITA’s workshops and activities and (5) the minor child(ren) listed below is at least ten (10) years of age, unless an authorized VIVITA representative initials here ______ indicating VIVITA’s acknowledgement that the minor child is at least eight (8) years of age, in which case you certify that the minor child is at least eight (8) years of age.  


I agree that this Agreement and all notices and disclosures made or given in connection with this Agreement may be created, signed, delivered, and retained electronically. As such, I agree that this Agreement may be signed electronically, and that the electronic signatures appearing on this Agreement shall have the same legal effect for all purposes, including validity, enforceability, and admissibility, as a handwritten signature. 



First Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
First Parent or Guardian's Age Acknowledgment*
First Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
First Parent or Guardian's Signature*
Second Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Second Parent or Guardian's Date of Birth*
Third Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Third Parent or Guardian's Date of Birth*
Fourth Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Fourth Parent or Guardian's Date of Birth*
Fifth Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Fifth Parent or Guardian's Date of Birth*
Sixth Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Sixth Parent or Guardian's Date of Birth*
Seventh Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Seventh Parent or Guardian's Date of Birth*
Eighth Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Eighth Parent or Guardian's Date of Birth*
Ninth Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Ninth Parent or Guardian's Date of Birth*
Tenth Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Tenth Parent or Guardian's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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