CONSENT, WAIVER, RELEASE, HOLD HARMLESS AND AUTHORIZATION TO REPRODUCE PHYSICAL LIKENESS
Welcome to LifeTown! We are so glad you are here and hope you have a great time.
To help keep you, your family, as well as other visitors safe while at LifeTown, we request that visitors to agree to some basic rules and sign a waiver legally protecting LifeTown.
The essence of this document is, that while we do our utmost to keep the facility and visitors safe, we cannot take legal responsibility to the actions that happen here.
As always, if you ever see something that concerns you, please bring it to the attention of our staff right away.
This is a Consent, Waiver, Release of Rights, Hold Harmless and Authorization Agreement ("Agreement”) between the Friendship Circle of New Jersey, Inc., LifeTown, Inc. and Chabad of Livingston, Inc., and affiliates, subsidiaries, officers, directors, employees, agents, contractors, and volunteers of each (collectively, “Friendship Circle”), and Participant and (collectively referred to herein as “I”, “me”, “my” and “Participant”). As used in this Agreement, Participant shall mean any individual, Parent of Guardian of a Participant under 18 years of age, student, mentor, teacher, volunteer, or other person or entity involved in with Friendship Circle or is present in the Friendship Circle building or is a participant in a Friendship circle Activity (collectively “Activity” or “Activities”). “Activities” means each and every activity arising from or related to the Participants visiting the Property, including, but not limited to, those included in the Medical Assistance and Photographs and Media section, herein.
Code of Conduct
I agree to follow the rules listed below as well as any additional rules that are posted in the facility or verbally expressed to me by Friendship Circle Staff.
- I agree to respect the privacy of all participants at LifeTown and to keep personal information that I may observe confidential.
- I will not use or possess any illegal drug, alcohol, tobacco or controlled substances at any time while at LifeTown.
- I will not bring or have any weapons, firearms or other dangerous items while on LifeTown property.
- I Will not participate in any activity that I believe I cannot perform in accordance with LifeTown activities’ instructions or in a safe manner;
- If I observe an actual or potential hazard during my participation in any event or program, I will stop participating in the event and inform LifeTown of such hazard immediately;
- I acknowledge that if I do not abide by these rules, LifeTown staff have the right to ask me to leave the facility, and if so I will follow that direction expeditiously.
Assumption of Risks
In consideration of my participation in one or more Activities, I agree to the following: I recognize that there may be risks associated with attending and/or participating in an Activity, including, without limitation, risks inherent in interacting with Friendship Circle and or being present in the Friendship Circle building. These risks include the risk of injury (including without limitation, physical and/or mental trauma, serious bodily harm and even death) and property damage. I ALSO UNDERSTAND THAT PARTICIPATION IN THIS ACTIVITY IS ENTIRELY VOLUNTARY. BEING FULLY COGNIZANT OF THE RISKS IN PARTICIPATING IN ANY SUCH ACTIVITY, I HEREBY FULLY AND WILLINGLY ASSUME THOSE RISKS. TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAWS, I, AND ON BEHALF OF MY CHILD, HEREBY WAIVE AND RELEASE ANY CLAIMS OR CAUSES OF ACTION WHICH I MAY NOW HAVE OR HEREAFTER ARISES AGAINST FRIENDSHIP CIRCLE RELATING TO OR CONNECTED TO MY PARTICIPATION IN ANY ACTIVITY, AND I WILL INDEMNIFY AND HOLD HARMLESS FRIENDSHIP CIRCLE AGAINST ANY AND ALL CLAIMS AGAINST ANY SUCH ENTITY OR PERSON RESULTING FROM SAME. The specific risks vary from one activity to another, but the risks include, but are not limited to, the following: minor injuries such as scratches, bruises, contusions, and sprains; major injuries such as eye injury or loss of sight, bone, joint or spinal cord injuries, strokes, heart attacks, and concussions; and Catastrophic injuries such as paralysis or death.
Release and Waiver
In consideration of being permitted to participate in the Activities, I and my successors, assigns, heirs, executors, administrators and personal representatives, do hereby release, waive, discharge, and covenant not to sue Friendship Circle from any and all claims, demands, liabilities, damages, costs and expenses, attorneys' fees, other professional fees and expenses, including, without limitation, negligently failing to adequately investigate or screen contractors, mentors, volunteers, etc., any claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever that I may now have or hereafter may arise against Friendship Circle in connection with my participation arising from, but not limited to Activities.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A WAIVER AND RELEASE OF LIABILITY AND IS EXPRESSLY INTENDED TO COVER AND INCLUDE ALL CLAIMS, PAST, PRESENT OR FUTURE, KNOWN OR UNKNOWN, WHICH CAN OR MAY EVER BE ASSERTED BY ME OR MY SUCCESSORS OR ASSIGNS AS THE RESULT OF PARTICIPANTS USE OF THE PROPERTY, OR THE EFFECTS OR CONSEQUENCES THEREOF.
In the event I should sustain any injuries or illness while attending and/or participating in an Activity, I hereby authorize FRIENDSHIP CIRCLE to administer, or cause to be administered, such first aid or other treatment and such medications as I may possess, as reasonably necessary under the circumstances, including, without limitation, treatment by a physician or hospital of FRIENDSHIP CIRCLE’s choice.
Photographs and Media
Participant understands that photographs, videotapes, and other recordings may be made of participants at such Activities, including the Participant. Participant consents to those photographs, videotapes, and other recordings and the use thereof (i) as part of a record of the Activity and (ii) in promotion of FRIENDSHIP CIRCLE. I further acknowledge that any works made by or for FRIENDSHIP CIRCLE (“Works”) to be “works made for hire,” under applicable copyright laws, and to the extent I have or may claim any rights in or to such Works, I hereby grant to FRIENDSHIP CIRCLE any and all such rights, including, without limitation, the right to use or sub-license these Works in any and all media, now known or later discovered or developed, and in all forms and for all purposes, including without limitation, advertising and other promotions for any FRIENDSHIP CIRCLE Activities, without any further consideration due to me or any limitation whatsoever.
This Release shall be binding upon my heirs, personal representatives, and me. THIS RELEASE SHALL BE GOVERNED BY AND CONSTRUED UNDER THE LAWS OF THE STATE OF NEW JERSEY, WITHOUT REGARD TO CONFLICT OF LAWS PRINCIPLES.
I UNDERSTAND THAT THIS FORM INVOLVES A RELEASE OF LEGAL RIGHTS.
Full Legal Name