Loading...

STEMbassadors Inc. IDEA Center

ASSUMPTION OF RISK, RELEASE, WAIVER OF LIABILITY and PARENT/GUARDIAN PERMISSION FORM


STEMbassadors Vision Statement

To inspire and create opportunities for future generations of scientists and engineers throughout the world.


STEMbassadors Mission Statement

To enhance the education of K-12 students by providing them with applied, state-of-the-art STEM materials,

curriculum and skills, and to create opportunities for them to share their acquired knowledge with others.


The IDEA Center owned and operated by STEMbassadors Inc., a California 501(c)(3) not-for-profit

corporation located at 1264 Ventura Avenue, Ventura, CA 93001, provides patrons with the opportunity to

use its IDEA Center facilities and equipment. All patrons use of IDEA Center facilities and equipment is

entirely optional and voluntary and is for the purpose of recreation, education, and/or self-improvement.

In order to participate in STEMbassadors’ IDEA Center, each Participant must submit a completed

Assumption of Risk, Release, Waiver of Liability and Parent / Guardian Permission Form signed by a

Parent or Legal Guardian (if Participant is a minor under the age of eighteen (18) years of age).

Participants who have not submitted a completed version of this form will not be permitted to participate

in the IDEA Center.


AGREEMENT TO PARTICIPATE


I agree to allow myself or my child/ward (any such Participant collectively referred to herein as the “Participant”) to

participate in STEMbassadors, Inc.’s (collectively referred to herein as “STEMbassadors”) IDEA Center and affirm that

this participation is completely voluntary. I understand and am fully aware of the risks and hazards inherent in the

activities in which Participant will engage in during the program that may cause personal injury, illness, paralysis,

permanent disability or even possibly death, and/or damage to property and assume full responsibility for any risks of

loss, damage or personal injury that may occur as a result of the activities Participant will engage in during the

program, regardless of whether the personal injury, loss or damage is caused by the negligence of STEMbassadors or

any of the Released Parties defined below. The risks and hazards include, but are not limited to, the following: trips,

slips, falls, cuts, broken bones, burns, and other wounds to hands, head, feet, eyes and other body parts;

electrical shock; exposure to dust, fumes, smoke, noise, and vibrations; accidents due to negligence of

other users or STEMbassadors staff or vendors, or due to defective or inadequate facilities, equipment,

tools, machinery, or due to inadequate maintenance or repair, training, instructions, supervision, first aid,

medical treatment, or safety gear. All above-referenced risks, hazards and other risks arising from the IDEA Center

activities are referred to herein as “Risks”. I also understand that, despite STEMbassadors’ reasonable efforts

to minimize these Risks, STEMbassadors cannot and does not guarantee that Participant will not be injured. By signing

this Assumption of Risk, Release, Waiver of Liability and Parent / Guardian Permission Form, the Participant and

Parent / Guardian (if Participant is a minor under the age of eighteen (18) years old) voluntarily assume these Risks in

order to participate. To minimize the Risks, the Participant agrees to obey all STEMbassadors policies and procedures,

including all IDEA Center policies, code of conduct, safety rules, regulations, and instructions of the instructor and

STEMbassadors.


ASSUMPTION OF RISK, RELEASE, WAIVER OF LIABILITY, RELEASE & AGREEMENT NOT TO SUE


In consideration for permitting Participant to participate in the STEMbassadors IDEA Center and to use

STEMbassadors’ facilities for said IDEA Center, I hereby voluntarily, irrevocably and unconditionally agree, for myself,

my family and for and on behalf of my child/ward, and our respective heirs, executors, administrators, estates,

affiliates, successors and assigns (collectively referred to herein as “Releasing Parties”):


1. TO ASSUME FULL RESPONSIBILITY FOR ANY RISKS, CLAIMS OR LOSS, OR PERSONAL INJURY,

INCLUDING DEATH that may be sustained by Participant, or any loss and/or damage to property owned by

Participant, as a result of participating in the IDEA Center.


2. TO IRREVOCABLY, FULLY AND UNCONDITIONALLY RELEASE, WAIVE, HOLD HARMLESS,

INDEMNIFY AND FOREVER DISCHARGE, AND COVENANT NOT TO SUE STEMbassadors, and/or its trustees, past

and present members of the board of directors, officers, employees, agents, volunteers, students, and staff

(collectively referred to herein as “Released Parties”) from and against any and all liabilities, claims, suits, actions,

demands, damages, losses, expenses, liabilities, obligations or costs of any kind and nature (including, but not limited

to, reasonable attorney’s fees, and other litigation and court costs), known or unknown, accrued or unaccrued,

absolute or contingent, at law or in equity, including without limitation, actions for breach of contract, fraud,

misrepresentation, tort or negligence, incurred by any of the Releasing Parties in connection with or arising out of or

relating to: (a) participation in the IDEA Center; (b) any breach or alleged breach of any warranty, representation,

contract actions, statutory duty or other duty of care by any Released Parties; (c) any act or omission to act of any

Released Parties or anyone acting on behalf of any Released Parties; and/or (d) any other causes of action whatsoever

that any of the Releasing Parties might now have or may acquire in the future, arising out of or related to any loss,

damage, or injury, including death, that may be sustained by any of the Releasing Parties, or to any property

belonging to any of the Releasing Parties, while traveling to or from, or participating in the IDEA Center. I

understand, without limiting the foregoing, that this is a full, absolute and unconditional release and

waiver of all possible claims, including any claims arising from the sole, concurrent, contributory or

comparative negligence or strict liability of any Released Party


3. THAT THIS AGREEMENT is executed and delivered and consummated in Ventura County, California, and shall be

governed by and construed in accordance with the laws of the state of California. Releasing Parties, for themselves

and their respective heirs, legal and personal representatives, successors and assigns, hereby irrevocably (a) submits

to the exclusive jurisdiction of the state district court in Ventura County, California, (b) waives, to the fullest extent

permitted by law, any objection that he/she/it may now or in the future have to the laying of venue of any litigation

arising out of or in connection with this Agreement brought in the district court of Ventura County, California, (c)

waives any objection he/she/it may now or hereafter have as to the venue of any such action or proceeding brought

in such court or that such court is an inconvenient forum, and (d) agrees that any legal proceeding against any Party

arising out of or in connection with this Agreement shall be brought in one of the foregoing courts.


CONSENT FOR MEDICAL TREATMENT OF MINORS


If the Participant is injured or becomes ill while involved in IDEA Center Activities or participating in the IDEA Center,

the Participant and Releasing Parties hereby authorizes STEMbassadors and its employees, volunteers, agents and

representatives to obtain and consent to, on the Participants’ behalf, medical care, including without limitation,

medical treatment, hospitalization, ambulance transportation, anesthesia, and X-ray and other exams and tests. The

undersigned Participant or Parent / Legal Guardian (if Participant is a minor under the age of eighteen (18) years old)

agrees to pay all costs of such medical care and transportation.


MINOR PARTICIPANT RELEASE


If only one Parent / Legal Guardian (for Participants under the age of eighteen (18) years old) is signing below, it is

agreed and understood that this document will be interpreted to mean that the signing Parent / Legal Guardian has

the requisite authority to act on behalf of both Parents / Legal Guardians, jointly and severally, and references to the

plural will be adjusted. Each Releasing Party agrees that the foregoing Assumption of Risk, Release, Waiver of Liability

and Parent / Guardian Permission Form is intended to be as broad and inclusive as is permitted by the law of the

State of California.

If any provision of this Agreement shall be held in violation of any applicable law or unenforceable for any reason, the

unenforceability of any such provision shall not invalidate or render unenforceable any other provision hereof.


The undersigned has read this foregoing Assumption of Risk, Release, Waiver of Liability and Parent /

Guardian Permission Form, fully understand its terms, signs it freely and voluntarily, and further agrees

that no oral representatives, statements or inducement apart from the foregoing written Assumption of

Risk, Release, Waiver of Liability and Parent / Guardian Permission Form have been made to any

Releasing Party.

By signing below, I acknowledge that I am eighteen (18) years of age or older, and am the Parent, or

Legal Guardian, or otherwise responsible person of Participant (if Participant is a minor under the age of

eighteen (18) years old) with full authority under the law to sign and enter into this Agreement for

Participant. I have read, understand and agree to the terms outlined above and am voluntarily

surrendering and releasing certain legal rights described herein.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
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*
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(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 Date of Birth*
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! and  Rock Gym Pro