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TEEN LOUNGE WAIVER AND RELEASE OF LIABILITY

Required for participation in The Cove LM., Inc. (“The Cove”) teen lounge activities

1. Acknowledgment of Risk & Voluntary Participation

I/we understand that participation in The Cove, a teen hangout program located in the Village of Larchmont, New York, is voluntary and may involve physical activities, social interaction, and use of shared or public facilities. These activities carry certain inherent risks, including injuries, illness, or property damage.

I/we knowingly and voluntarily assume all risks associated with participation, in accordance with New York law. I am responsible for any personal property brought on the premises.


2. Code of Conduct

All participants are expected to adhere to a comprehensive Code of Conduct, which promotes a safe, respectful, and inclusive environment. This Code includes behavioral expectations, prohibited actions, and consequences for misconduct.

The full Code of Conduct which is attached as Appendix A, is fully incorporated herein.

Violations may result in immediate dismissal from the program without further warning.


3. Drugs, Alcohol, and Prohibited Substances

Pursuant to New York State law, the possession, use, or distribution of the following is strictly prohibited on the premises of The Cove:

  • Alcohol
  • Illegal drugs (including marijuana for recreational use, which remains prohibited for minors under New York law)
  • Tobacco, vaping devices, and e-cigarettes (per NYS Public Health Law Article 13-F)
  • Weapons or hazardous items of any kind

Violation of this policy will result in immediate removal from the program and, if necessary, involvement of local law enforcement.


4. Prohibited Activities

The following activities are strictly prohibited before, during and after attending an event at The Cove:

  • Loitering on Flint Park grounds when the park is closed 
  • Vandalizing or damaging facilities within Flint Park, including The Cove facility 
  • Harassment, intimidation, bullying, or fighting of any kind.

Violation of this policy will result in immediate removal from the program and, if necessary, involvement of local law enforcement.


5. Screen-Free Environment

The Cove promotes a screen-free space. Use of cell phones, tablets, or other personal electronic devices may be limited or restricted during program hours, unless required for emergency purposes.


6. No Guarantee of Supervision

I/we understand that while adult staff and volunteers will be present to oversee general activities, The Cove is not a licensed childcare provider under New York State Office of Children and Family Services (OCFS). Continuous individual supervision is not guaranteed.

In the event of injury or illness, The Cove is not responsible for providing medical care. Parents/guardians are solely responsible for all medical decisions and costs related to their child’s care.


7. Release of Liability – Pursuant to New York Law

In consideration of my child’s participation in The Cove, I/we hereby release, waive, discharge, and hold harmless the The Cove, the Village of Larchmont, and their employees, officials, volunteers, agents, sponsors, and affiliates (collectively, the “Releasees”) from any and all claims, causes of action, damages, penalties, fines, expenses (including attorneys’ fees), or liability for personal injury, illness (including COVID-19), death, property damage, or loss arising out of or related to:

  • Participation in The Cove program;
  • Presence in or around The Cove facility or the surrounding Flint Park area;
  • Traveling to or from The Cove, whether on foot, by vehicle, or other means, including during evening or nighttime hours; and
  • Activities or interactions arising from involvement in The Cove.

The Releasees shall not be liable for any lost, stolen, or damaged personal property.

This Waiver and Release applies to the fullest extent permitted under New York General Obligations Law § 5-326 and relevant case law, recognizing that while certain waivers may not relieve municipalities of liability for gross negligence or willful misconduct, this waiver is intended to limit claims arising from ordinary negligence or inherent risks.

This Waiver and Release has been executed under and shall be governed by the laws of the State of New York without regard to the state’s conflict of law principles.


8. Photo & Media Release

By participating in The Cove, I/we acknowledge and agree that my child may be photographed, videotaped, or otherwise recorded during program activities. These images or recordings may be used by The Cove or its affiliates for promotional or informational purposes, including on websites, social media, printed materials, and presentations.

Participation in The Cove constitutes automatic consent to such media use.


Appendix A

THE COVE RULES AND CODE OF CONDUCT

Welcome to The Cove!

This is your spot to hangout, make friends, and have fun — safely and respectfully.

By signing below, you agree to follow these guidelines so everyone can enjoy their time here.

1. Check In & Out

  • Sign in when you arrive and sign out when you leave.
  • Drop your phone in the phone box and take your number.  For urgent matters, students may step outside or use the landline.
  • For weekend evening events, no backpacks or large bags are allowed.  Once you sign-out, there is no re-entry.  Students must leave the park immediately as the park is otherwise closed. 

2. Respect the Space

  • Keep The Cove clean — clean up after yourself.
  • Do not tamper with, damage, or misuse any event or park equipment or facilities.
  • Put games, cards, and equipment back where you found them.  
  • Treat the space, furniture, and supplies with care.

3. Respect Each Other

  • Be kind, inclusive, and respectful – to everyone 
  • Listen to adult and student leaders and follow directions, especially in emergencies.
  • No bullying, fighting, harassment, or intimidation.
  • No inappropriate or sexual behavior of any kind.-- keep it safe and respectful. 

4. Be Safe

  • Absolutely no alcohol, vaping, drugs, tobacco, or misused medications– zero tolerance.
  • Do not bring, share, or use these substances.
  • Do not arrive under the influence of anything.

By attending The Cove, I agree to follow this Code of Conduct.  I understand that failure to do so may result in my removal or further consequences.  


Today's Date: November 20, 2025

First Parent or Guardian Name
First Name*
Last Name*
First Parent or Guardian Age Acknowledgment*
First Parent or Guardian Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Parent or Guardian Information
Minor(s) Grade:*
First Parent or Guardian Signature*
Second Parent or Guardian Name
First Name*
Last Name*
Parent or Guardian Date of Birth*
Date of Birth
Second Parent or Guardian Information
Minor(s) Grade:*
Third Parent or Guardian Name
First Name*
Last Name*
Parent or Guardian Date of Birth*
Date of Birth
Third Parent or Guardian Information
Minor(s) Grade:*
Fourth Parent or Guardian Name
First Name*
Last Name*
Parent or Guardian Date of Birth*
Date of Birth
Fourth Parent or Guardian Information
Minor(s) Grade:*
Fifth Parent or Guardian Name
First Name*
Last Name*
Parent or Guardian Date of Birth*
Date of Birth
Fifth Parent or Guardian Information
Minor(s) Grade:*
Sixth Parent or Guardian Name
First Name*
Last Name*
Parent or Guardian Date of Birth*
Date of Birth
Sixth Parent or Guardian Information
Minor(s) Grade:*
Seventh Parent or Guardian Name
First Name*
Last Name*
Parent or Guardian Date of Birth*
Date of Birth
Seventh Parent or Guardian Information
Minor(s) Grade:*
Eighth Parent or Guardian Name
First Name*
Last Name*
Parent or Guardian Date of Birth*
Date of Birth
Eighth Parent or Guardian Information
Minor(s) Grade:*
Ninth Parent or Guardian Name
First Name*
Last Name*
Parent or Guardian Date of Birth*
Date of Birth
Ninth Parent or Guardian Information
Minor(s) Grade:*
Tenth Parent or Guardian Name
First Name*
Last Name*
Parent or Guardian Date of Birth*
Date of Birth
Tenth Parent or Guardian Information
Minor(s) Grade:*
Parent or Guardian Email Address
Email
Check to receive information, news, media consent, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant

By signing, I acknowledge that I have read and fully understand this Waiver and Release, and voluntarily agree to all terms. I give permission for my child to participate in The Cove.



By signing, I acknowledge that I have read and fully understand this Waiver and Release, and voluntarily agree to all terms. I give permission for my child to participate in The Cove.

Parent or Guardian Name
First Name*
Last Name*
Phone*
Parent or Guardian Age Acknowledgment*
Parent or Guardian Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian Information
Minor(s) Grade:*
Parent or Guardian 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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