Loading...

General Waiver and Release Agreement

 

Please Note: Thrive Mat-Su and Youth 360 are programs of the United Way of Mat-Su. Therefore, everywhere United Way of Mat-Su is referenced throughout this document Youth 360 and Thrive Mat-Su are included as well.

STATEMENT OF PURPOSE: Youth have valuable perspectives, knowledge, and experience to share with their community and are an important partner in community wellness. Additionally, when our youth live in healthy settings and have access to environments and opportunities where they can find and grow their strengths, where they can build positive social connections and develop strong identities, where they feel like they matter, youth can be healthy, have confidence, and flourish.

ACCEPTANCE OF RISK: I understand that the activities or programs my child will be engaging in or upon the premises of the UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360, using any of its facilities, services or equipment, or participating in any program or activity provided or sponsored by UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 are inherently risky and potentially hazardous and I hereby accept full responsibility for, and risk of, any injury, including death, accidents, disability, illnesses to my child that may occur as a result thereof.

I hereby give permission for my child to participate in these activities or programs, assuming all ordinary risks normally inherent to the nature of the activities or programs. Such activities or programs include, but are not limited to, the following: aerobics, Airsoft, archery/axe throwing, arts & crafts, baking/candy making, badminton, backpacking, baseball, basketball, biking/BMX, bowling, camping, concerts, cooking, dance, disc golf, dodgeball, football, field trips, fishing/ice fishing, group games & sports, gymnastics, hiking, horseback riding, ice skating, inflatables, kayaking/canoeing, LARPing (Live Action Role Playing), lock-ins, makers (woodshop, welding, etc.), martial arts, music, Nerf guns, parkour/ninja course, performing arts, physical education, rock climbing, running/jogging, skateboarding, skating, skiing/snowboarding, sledding/tubing, snowshoeing, soccer, swimming/slip-n-slide, tennis, trampoline, weight training, wilderness studies/survival classes, and yoga.

My child agrees to abide by all rules set by UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360, regarding all activities or programs, including but not limited to, rules relating to personal behavior and safety. My child and I realize that some of these activities or programs may subject the participants to certain stresses and hazards, not all of which can be foreseen. I confirm that my child is in good health and in proper physical condition to participate in such activities or programs.

I hereby release, waive and covenant not to sue the UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360, its successors and assigns, and its directors, officers, employees, and agents (collectively, the “Releases”) from all claims, demands, damages, losses and causes of action arising or resulting from death, disability, or any injury to my child or loss or damage to my child’s property that may occur while my child is in or upon the premises of the UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 or using any of its facilities, services or equipment, or participating in any UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 program or activity.

I hereby indemnify and hold harmless the Releases from all loss, liability, damage, or cost they may incur due to my child’s presence in or upon the premises of the UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 or use of its facilities, services or equipment, or participation in any UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 program or activity.

I understand that this waiver does not prospectively waive any claim my child might have against UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 for reckless or intentional misconduct or gross negligence.

HEALTH AND SAFETY: I agree to advise my child that wearing an approved U.S.C.G. personal flotation device for waterborne activities or programs is required. I agree to advise my child to wear a helmet for any activity in which when one is required. I agree to advise my child to wear a mask when one is required. I agree to advise my child that following instructions, observing safety precautions, and following UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 rules, policies, and applicable laws is required. I will remind my child that accidents in the wilderness can have very serious consequences.

TREATMENT AUTHORIZATION/MEDICAL FEES: In the event of injury, UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 will first attempt to contact the Parent/Guardian and the designated Emergency Contact. Should those contacts not be available, I hereby authorize the Releases to provide or cause to provide any medical care and treatment, and transportation to said medical care and treatment, deemed necessary and appropriate to my child. I affirm that I have appropriate insurance, or, in its absence, I hereby agree to be fully and solely responsible for all fees and costs arising from any medical conditions or treatments for my child’s participation including, but not limited to, the administration of emergency medical care. I certify that my child has no medical, physical, or mental limitations that could interfere with his/her safety in UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 activities or programs, or that I willingly assume and will bear the costs or damages arising out of any risks that may be created, directly or indirectly, by any such limitation. I agree to hold UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 harmless for the nature, performance, and outcome of any such emergency medical treatment and that the determination of whether an emergency has arisen shall be left to the sole discretion of UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360. 

MEDIA RELEASE: I consent to the use, publication, and display, by or on behalf of UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360, of any photograph, video or digital image and any reproduction thereof in which my child or I may be portrayed or identified. UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 may use, publish, broadcast, and display such photographs, videos, digital images, or reproductions thereof, in whole or in part, for any business purpose in their individual discretion, including social media and media coverage of UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360.  If you do not wish to provide a media release, please contact us at Connect@ThriveMatSu.org

TRANSPORTATION CONSENT: By enrolling Student(s), Parent/Guardian hereby authorize the transportation of student to and from all field trips, activities or programs, and locations where transportation is provided. No student will be released to any other person other than his or her parent/guardian without specific written authorization. Staff members or volunteers are not permitted, at any time, to be alone with a minor in a car or other vehicle.

PERSONAL PROPERTY: UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 assumes no liability for loss or damage to Student’s personal property or for injury incurred because of use of personal property. UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 discourages all borrowing and lending among Students of personal property. UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 assumes no responsibility for money or valuables brought to activities or programs/events/youth clubs by Students. Students will be held responsible for damage to property and equipment of UNITED WAY OF MAT-SU/THRIVE MAT-SU/YOUTH 360 caused by Student’s negligence and will be charged accordingly for repairs or replacement.

PARTICIPANT CODE OF CONDUCT: Students are expected to uphold a culture and atmosphere of respect and consideration of others. Programs, activities, and events strive to provide an environment in which participants feel connected, valued, and supported.

If a participant is displaying signs of unwanted behavior, staff and volunteers will offer support, facilitate problem-solving, and encourage self-control and self-regulation. Should strength-based support not address unwanted youth behavior, United Way of Mat-Su/Thrive Mat-Su/ Youth 360 has the right to dismiss any student whose behavior, attitude, or action, is contrary to the best interests of our student community. This includes but is not limited to: pranks causing bodily harm, violent or hostile behavior, destruction of property, bullying, emotional abuse, sexual harassment, theft, use or possession of controlled substances, use of weapons, or for other conduct that is ruining another student’s experience or is harmful to the activity or program.

It is understood and agreed, by Students and Parent/Guardians, that possession or use of tobacco, alcohol, controlled substances, e-cigs or vaping, marijuana, or weapons while participating in programs and activities or programs will bring immediate dismissal.

CHILD ACKNOWLEDGEMENT: I hereby acknowledge that I have reviewed all the expectations, terms, conditions, and stipulations found in this Agreement with my child/children.

ALASKA LAW: I agree that any dispute or claim concerning this Agreement, shall be resolved exclusively by mediation and binding arbitration in the State of Alaska. Alaska law shall govern this Agreement.

This General Waiver and Release Agreement is entered into by and between United Way of Matanuska-Susitna Borough (United Way of Mat-Su) and the undersigned Parent/Guardian on behalf of their child/children participating in United Way of Mat-Su/Thrive Mat-Su/Youth 360 activities or programs. The Parent/Guardian hereby acknowledges and agrees that for the good and valuable consideration of the opportunity for the Minor Participant to participate in activities or programs, events, and field trips Parent/Guardian hereby agrees to be bound by this Agreement. The term of this Agreement shall be in effect for one year from the date of the Agreement.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE GENERAL WAIVER AND RELEASE AGREEMENT AND OTHER PROVISIONS SET OUT ABOVE.

Today's date: August 14, 2022

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
First Participant's Signature*
Second Participant's Name

First Name*

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

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
Third Participant's Name

First Name*

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

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
Fourth Participant's Name

First Name*

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

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
Fifth Participant's Name

First Name*

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

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
Sixth Participant's Name

First Name*

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

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
Seventh Participant's Name

First Name*

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

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
Eighth Participant's Name

First Name*

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

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
Ninth Participant's Name

First Name*

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

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
Tenth Participant's Name

First Name*

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

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive Thrive's Monthly Newsletter & Schedule of Activities
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Additional Information:
When transportation is available, does your child need transportation to be able to participate in activities, events, and programs?*
No
Yes
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Allergies:

Medical Conditions:

Physical/Emotional Limitations:
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!