Facility User/Field Trip Agreement

RELEASE OF LIABILITY, WAIVER OF CLAIMS

AND ASSUMPTION OF RISK AGREEMENT

Release and Waiver of Claims

I agree to follow all rules and regulations of Keeta’s Place while in, upon or about the premises or while using or observing the premises or any facilities or equipment, or participating in any program affiliated with Keeta’s Place without respect to location, and understand and agree that I may be expelled at any time for failure to abide by such rules and regulations.

In consideration of being permitted to utilize the facilities, services or programs of Keeta’s Place for any purpose, including but not limited to observation or use of facilities or equipment or participate in any program affiliated with Keeta’s Place without respect as to location, I hereby agree to the following:

I. I understand that activities at the facility or elsewhere, including use of equipment and  participation  in programs, can involve movement, strain and other elements that create risk of serious injury or death. I also understand that program activities include field trips to locations outside of Keeta’s Place premises as described in detail in the program materials, and that public or private transportation may be utilized to transport participants to and from these field trip locations. I hereby assume full responsibility for and risk of bodily injury, death or property damage or loss, regardless of severity, that I or my minor child/ward may sustain from my or my minor child/ward’s presence in, upon or about the premises or while using or observing the premises or any facilities or equipment or participating in any program affiliated with Keeta’s Place without respect as to location, or while being transported to and from field trip locations outside the Keeta’s Place premises.

II. I, For myself, any personal representatives, assigns, heirs and next of kin, hereby fully release, waive, discharge and covenant not to sue Keeta’s Place, its operating centers, their respective officers, directors, Board of Directors, Trustees, members, volunteers, employees or agents (the Releasees) and each of them from any and all claims for injuries, damages or loss that I or my minor child/ward may have or which may accrue to me or my minor child/ward from my and/or my minor child/ward’s presence in, upon or about the premises or while using or observing the premises or any facilities or equipment, or participating in any program affiliated with Keeta’s Place without respect as to location, or while being transported to and from field trip locations outside the Keeta’s Place premises.

III.   I hereby agree to indemnify and save and hold harmless the Releases and each of them from any loss, liability, damage or cost they may incur from my or my minor child/ward’s presence in, upon or about the premises or while using or observing the premises or any facilities or equipment, or participating in any program affiliated with Keeta’s Place without respect as to location, or while being transported to and from field trip locations outside the Keeta’s Place premises.

The agreement applies to all past, present and future visits and uses by me to any Keeta’s Place facility or property.

I have read and voluntarily signed this assumption of risk, release, waiver and indemnity agreement, and further agree that no oral representation, statements or inducements apart from the foregoing written agreement have been made.

I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

Parent or Guardian must sign if the participant is UNDER 18.

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Photo Liability Waiver

I understand that my child’s photo may be taken by Keeta’s Place or program partners on occasion, and I hereby grant permission for my child’s name and likeness to be used for any legitimate purpose in any media now or hereafter.

This Waiver MUST Be Signed By A Parent or Guardian And Turned In Before Your Child Is Allowed To Become A W.O.T. Girl