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Harlem Meer Summer Festival

Waiver and Release from Liability


REGISTRATION & RELEASE OF LIABILITY WAVIER

In consideration of my participation in Central Park Conservancy’s Harlem Meer Moves program (the “Program”), I (or parent/guardian, if participant is under 18 years of age) agree to the following: 

1. I acknowledge and fully understand that I will be engaging in fitness activities/classes including, but not limited to yoga, dance, Funkaerobics, Double Dutch and other activities that involve risk of serious injury and/or damage to personal property and understand that my participation in the Program is voluntary. 

2. I hereby release, waive and discharge and covenant not to sue Central Park Conservancy, Inc. Double Dutch Dreamz, Harlem Yoga Studio, Go Hard Dance LLC, the City of New York and their respective commissioners, directors, officers, employees, agents, successors and assigns, all of which are hereinafter referred to as “Releasees”, from any and all liability for any and all claims, demands, losses, or damages, including death or damage to property, which, in whole or in part, arise from, relate to, or are alleged to arise from or relate to the Program, any and all related events and activities in which I am participating or the facilities or equipment used by me or by others, or are caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise to the fullest extent of the law, and I covenant not to sue the Releasees with respect thereto. 

3. This waiver may not be modified in any way.  

4. If any part of this waiver is determined to be invalid by law, all other parts of this waiver shall remain valid and enforceable.  


First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
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Emergency Contact

Emergency Contact Full Name *

Emergency Contact Telephone 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*

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. I hereby authorize and give my consent to participation in interviews, the use of quotes, and the taking of photographs or videotapes of myself (collectively, “Media”) by the Central Park Conservancy. I also grant the Central Park Conservancy the right to edit and to use said Media for any and all purposes including but not limited to publicity, electronic and print publications, Websites, and all other forms of media. I also hereby release all Releasees from any and all claims, demands, and liabilities whatsoever in connection with the above.


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