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Summer Camp Waiver

Step 1 of 2

MM slash DD slash YYYY
Event Date

1. Voluntary Participation.
I, the undersigned, as the parent or legal guardian of the child listed on this application (“Stated Minor”), acknowledge that I have voluntarily applied for the child to participate in the beading party, camp(s), and/or workshop(s) (“Activities”) by Dragonfly Designs, LLC (“Dragonfly Designs”) at the premises of the designated beading party host, or at the premises of Dragonfly Designs
2. Assumption of Risk.
I AM AWARE THAT PARTICIPATING IN BEADING AND/OR CAMP ACTIVITIES MAY BE HAZARDOUS DUE TO POSSIBLE INGESTION, INJURY OR ANY OTHER FORESEEABLE OR UNFORESEEABLE RISKS TO THE STATED MINOR, MYSELF AND/OR PROPERTY. I VOLUNTARILY AUTHORIZE THE STATED MINOR’S PARTICIPATION IN THESE ACTIVITIES WITH FULL KNOWLEDGE OF THE POTENTIAL DANGERS INVOLVED. I HEREBY AGREE TO ACCEPT ANY AND ALL RISKS INCLUDING BUT NOT LIMITED TO PERSONAL OR REAL PROPERTY DAMAGE, INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE: .
3. Release of Liability..
As consideration for being permitted by Dragonfly Designs to participate in these activities, use related facilities and beading equipment, I hereby agree that I, my assignees, heirs, distributees, guardians, and legal representatives will not make a claim against, sue, or attach the property of Dragonfly Designs on account of any personal or real property loss or damage, nor any claims or demands therefor on account of injury to the person or death of the stated minor. The aforementioned is true whether such damage is caused by the negligence or other acts by an employee, agent, relative, third party contractor (collectively “Employees”) of Dragonfly Designs or otherwise while the stated minor is in, upon, or about any premises under Dragonfly Design’s control. This includes, but is not limited to, all liability for damages or injury resulting from the active or passive negligence of Dragonfly Designs and employees while the stated minor is under its care. I hereby release, discharge, and agree to indemnify Dragonfly Designs from all actions, claims, damages, costs or demands that I, my assignees, heirs, distributees, guardians, and legal representatives now have or may hereafter have for any of the loss or damage mentioned above arising or resulting directly or indirectly from the minor’s participation in the activity.
4. Personnel Policies.
To the extent that Dragonfly Designs deems necessary, a safety talk about the proper handling of equipment will be given prior to beginning the activity. Dragonfly Design’s employees will reasonably supervise participants during the contracted activity duration. It is further warranted that such participation and use of any equipment constitutes an acknowledgment that such beading equipment and activity tools thereon have been inspected and that the undersigned accepts said equipment as being safe and reasonably suited for such intended use. The primary concern of Dragonfly Designs is personal safety and the capability of all children under its care to be able to control one’s body. Understanding this, I state to the best of my knowledge, the stated minor has no medical, physical, mental, or emotional health conditions that would hinder his/her participation in a Dragonfly Designs activity. INITIAL HERE: .
5. Medical Permission Authorization
In the event of a medical emergency, while the stated minor is under Dragonfly Design’s care, Dragonfly Designs will attempt to notify the contracted Primary Contact by telephone. If the Primary Contact cannot be reached immediately, the listed Emergency Contact will be telephoned. If applicable, additional medical authorization agreements are incorporated by reference and shall be controlled in the event of a conflict.
6. Knowing and Voluntary Execution.
I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN DRAGONFLY DESIGNS AND ME AND I SIGN IT AT MY OWN FREE WILL.
PERSONAL IMAGE AND VIDEO RELEASE FORM
I attest that I am the parent or legal guardian of the minor(s) listed below. I hereby give my consent for Dragonfly Designs, LLC (or “Dragonfly Designs”) to use either my, or the undersigned stated minor’s: photograph, silhouette, likeness, recorded voice, performances, poses, acts, and appearances in its publications. This use includes but is not limited to Dragonfly Design’s website, advertisement video, unlimited distribution and any other reproduction. Dragonfly Designs promises to not identify children in any way. Accordingly, I release both the stated minor and myself from any expectation of confidentiality, and/or rights of publicity. Furthermore, I release all claims against Dragonfly Designs with respect to copyright ownership and publication including any claim for compensation related to use of such materials. I have read the foregoing and fully understand the meaning and effect thereof and, intending to be legally bound, I have signed this release. Failure to sign and return this document represents your intent to not be bound by these conditions.
Image and Video Release(Required)
MM slash DD slash YYYY

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