Winnetka-Welcome

Camp Waiver Form

Release & Waiver of Liability & Assumption of Risk Agreement
For good and valuable consideration, including permission to participate in The Broadway Break Thru® at Winnetka Community House between August 4th – 9th, 2014.

Consent to the minor’s participation in the event or activity and agree that prior to the event or activity, if we deem necessary, the minor and I will inspect the facilities, equipment, and areas where the event or activity is being conducted and if either of us believes any of them are unsafe, I will immediately advise the person supervising the event, facility, or area.
Acknowledge that the minor and I fully understand that the minor’s participation may involve serious injury or death, including economic losses, which may result not only from the minor’s actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities equipment, or areas where the event or activity is being conducted, the rules of play for this type of event or activity.
Release, wave, discharge, and relinquish the Broadway Break Thru ®, Winnetka Community House, David Petro, and any employees, volunteers, teachers, or counselors working for BBT from any loss, damage, claim, demand of cause of action against them attributable to the minor’s participation in the event/activity whether same shall arise by their negligence or otherwise.
Assume any and all risks or personal injuries to the minor and authorize the Broadway Break Thru®, and all of it’s employees, Winnetka Community House, David Petro to contact or employee a licensed physician to render any medical treatment that may be deemed necessary for the minor or to take and admit the minor to any hospital. If such medical treatment or hospitalization is required, I agree to pay all medical and hospital bills relating there to, permanent or partial disability or death or damages to the minor’s or my property caused by or arising from the minor’s participation in the event or activity.
Covenant not to sue or present any claim for personal injury, property damage or wrongful death for or on behalf of the minor against Broadway Break Thru®, Winnetka Community House, David Petro and their officers, employees, volunteers, and agents attributable to the minor’s participation in the event or activity.
Agree that photographs, pictures, slides, movies, or videos of the minor may be taken in connection with the minor’s participation in the event or activity without compensation from The Broadway Break Thru®, Winnetka Community House, David Petro and consent to the use of the photographs, pictures, slides, movies, or videos for any legal purpose and agree that said content is the sole property of the Broadway Break Thru® and can be used for such purposes.
I understand that Broadway Break Thru® has rules and policies set in place to provide a safe and kid-friendly atmosphere. In registering for, and participating in, the programs and services provided by Broadway Break Thru®, I understand that my child(ren) and I must adhere to and follow any rules and policies as well as terms and conditions set forth by Broadway Break Thru®. At the discretion of the owners, management and/or staff, Broadway Break Thru® reserves the right to deny service to anyone.
In the event of an accident or emergency, I hereby consent to Broadway Break Thru® obtaining medical care from any licensed physician, hospital or clinic, including transportation and emergency medical services, for my child(ren).
Warrant that the minor is in good health and has no physical condition that would prevent the minor from participating in the event or activity. Important: This document relieves the Broadway Break Thru®, Winnetka Community House, and the employees of the Broadway Break Thru®, including David Petro and others from liability for personal injury, wrongful death, and property damage caused by negligence.