Loading...

WAIVER, RELEASE, AND HOLD HARMLESS AGREEMENT

  • TCC refers to The Chris Center
  • Participant refers to a child participating in a TCC program
  • Parent/Guardian refers to the Participant’s parents and/or guardians (or, if Participant is 18 or older, Parent/Guardian includes the Participant)
  • Released Parties refers to TCC, its respective officers, directors, employees, volunteers or agents

In order to participate in TCC’s programs, TCC requires that a Parent/Guardian sign this waiver, release, and hold harmless agreement. By signing this document, Parent/Guardian agrees that it will make no claim nor file suit for any injury to person or property, or for any loss or destruction of any personal property. Parent/Guardian understands that the Released Parties accept no legal responsibility for accidents, damage, injury, or illness due to the animals, members, sponsors, agents, spectators, or any other person or property owner in connection with the operation of TCC programs.

Parent/Guardian understands that there are inherent risks in any participation in TCC programs and those risks are assumed by Parent/Guardian, who fully assumes the responsibility for the risk of injury or worse caused by the Participant’s or Parent/Guardian’s contact with any animals or caused by participation in TCC programs.

As a condition of Participant (and if applicable, Parent/Guardian) using the facilities and the programs of TCC, Parent/Guardian, WAIVES, RELEASES TCC and other Released Parties from, and HOLDS HARMLESS TCC and other Released Parties from, claims and liabilities arising out of any act or omission of TCC or other Released Parties, whether or not caused in whole or part by negligence or fault of TCC or other Released Parties. This WAIVER, RELEASE, and HOLD HARMLESS agreement applies to any and all liability for any and all injuries to Participant (and if applicable, Parent/Guardian), or damage to persons or property, or other losses, caused by contact with animals or caused by any other activities taking place in connection with TCC programs, whether such injuries or damage result from negligence or fault in whole or in part of TCC or other Released Parties.

Parent/Guardian understands that the services provided by TCC are not offered as a substitute for clinical mental health care or medical care and are not intended to diagnose, treat, or cure any mental health or medical conditions.

Signing of this form binds Parent/Guardian to this WAIVER, RELEASE, and HOLD HARMLESS agreement.

Date: October 9, 2024

First Participant's Name

First Name*

Middle Name

Last Name*
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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
Third Participant's Name

First Name*

Middle Name

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
Fourth Participant's Name

First Name*

Middle Name

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
Fifth Participant's Name

First Name*

Middle Name

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
Sixth Participant's Name

First Name*

Middle Name

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
Seventh Participant's Name

First Name*

Middle Name

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
Eighth Participant's Name

First Name*

Middle Name

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
Ninth Participant's Name

First Name*

Middle Name

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
Tenth Participant's Name

First Name*

Middle Name

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
Parent or Guardian's Email Address

Email*

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

The Chris Center, Inc.
MEDIA WAIVER

I authorize The Chris Center, Inc. (TCC) permission to use photos and videos of me (or my child if signed by a parent or guardian), as well as verbal or written feedback from me (or my child if signed by a parent or guardian) about the program and experiences. I understand this information may be used in printed or electronic form including social media for publications, promotional literature, grant writing purposes, education, or any other use for the benefit of TCC program(s). *
I DO
I DO NOT
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!