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Release of Liability Waiver

Inspire One Foundation
6569 N. Riverside Drive #102-244
Fresno, CA 93722

Licia@Inspire-1.org
Leeann@Inspire-1.org





HERE'S ALL THE IMPORTANT LEGAL STUFF WE NEED TO SAY--

GENERAL LIABILITY RELEASE:

I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.

In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. 

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the organization or participation in organization-related activities (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the organization, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any organization-related activity.

I understand and agree that the law of the State of California will apply to this Waiver of Liability. I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS WAIVER OF LIABILITY, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE:

MEDIA RELEASE:

I understand and authorize that I or my minor child(ren) may be photographed or filmed and used in video presentations, and printed publications-either digital (online) or paper publications. Any exception must be received in written form prior to the date of the event.

IMPORTANT INSURANCE NOTE: In the event of an injury to the attendee, it is the policy of the organization that the individuals insurance be primary and Inspire One Foundation medical coverage be secondary up to a maximum of $10,000.



First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
REMIND APP REQUIREMENT
ALL families will be added to the REMIND GENERAL INFO CLASS upon registration. This will be our MAIN means of communication with our families. By clicking below, I certify that I UNDERSTAND & AGREE to these terms.*
I UNDERSTAND & AGREE
Insurance

Insurance Carrier*

Insurance Policy Number*
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*

Last Name*

Relationship*

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 Information

MINORS ONLY: Current year grade level *

Allergies (Please include food allergies)

Last Tetanus Shot (if known)

Medications Taken/Medical Conditions
Please select all that apply for this participant only. *
Beginning Choir
Children's Choir
Youth Choir
Concert Choir
Girl's Ensemble
Guy's Ensemble
Community Choir
Contra Dance
Pre-Ballet
Beginning Ballet
Ballet I
Ballet II
Beginning Handbells
Intermediate Handbells
Advanced Handbells
Individual Piano Lessons
Individual Violin Lessons
Other Class or Lesson
Volunteer
Staff/Board

If you selected "Other Class or Lesson" above, please list name of all classes and/or lessons & teacher here for this participant only. (Type n/a if not applicable.) *
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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