RELEASE OF LIABILITY - DOC
Shared by: HC120829191810
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- views:
- 21
- posted:
- 8/29/2012
- language:
- English
- pages:
- 1
Document Sample


RELEASE OF LIABILITY
PLEASE READ CAREFULLY!
I GIVE MY CONSENT for the minor child listed on this agreement and registration form to
participate in The Spark Fitness childcare program. I agree to abide by all the terms and policies
of The Spark Fitness childcare program as outlined in this agreement.
I UNDERSTAND AND AGREE TO RELEASE SPARK FITNESS, LLC FROM ANY AND ALL
LEGAL LIABILITY AND AGREE NOT TO SUE OR MAKE A CLAIM AGAINST, AND TO
INDEMNIFY AND HOLD HARMLESS SPARK FITNESS, LLC, THE OWNER, AND STAFF OF
THE SPARK FITNESS CHILDCARE PROGRAM FOR ANY AND ALL CLAIMS FOR DAMAGE,
INJURIES, OR DEATH TO SAID MINOR CHILD OR ANY PERSON OR PROPERTY CAUSED
BY OR RESULTING FROM SAID MINOR CHILD PARTICIPATION IN THE SPARK FITNESS
CHILDCARE PROGRAM.
I GIVE CONSENT to The Spark Fitness childcare program staff to provide any and all emergency
first aid treatment and or refer treatment to a duly licensed physician (MD), Dentist (DDS), or other
medical provider to the participant. This care may be given under whatever conditions are
necessary to preserve the life, limb, or well being of the participant. I authorize said minor’s
transportation to a medical facility, at my expense, as deemed necessary by Spark Fitness, LLC.
I hereby grant exclusive permission to Spark Fitness, LLC and it agents, to use my child’s name
and photograph for the purpose of publicity, public relations, editorial, or other marketing program
without restriction as to frequency or duration.
If I am signing this liability release on behalf of a minor, (less than 18 years of age) I represent that
I am the parent and or legal guardian of said minor child; I accept responsibility for all the medical
expenses incurred in connection with the program: I agree to indemnify the released parties for
any and all claims whatsoever brought by the child; and I agree to indemnify the released parties
for any and all claims brought by a third party arising in connection with the child.
I HAVE READ AND AGREE TO ALL THE ABOVE POLICIES AS OUTLINED IN THIS
REGISTRATION FORM AND RELEASE OF LIABILITY. I UNDERSTAND THAT FAILURE TO
FOLLOW ANY CHILDCARE CENTER OR STATE OF COLORADO POLICIES MAY LEAD TO
DENIAL OF THE CHILD’S PARTICIPATION IN THE PROGRAM. I VERIFY THAT I AM THE
PARENT OR LEGAL GUARDIAN OF THE SAID MINOR CHILD AND I AM OF AUTHORITY TO
ENTER INTO THIS AGREEMENT ON BEHALF OF THE SAID MINOR AND MYSELF, AND I
AGREE TO BE BOUND BY ITS TERMS.
CHILDS NAME DATE
PRINT PARENT/GUARDIAN NAME
SIGANTURE OF PARENT/GUARDIAN
1
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