Pages: [1]   Go Down
  Print  
Author Topic: Children Program - Liability Waiver Form  (Read 11572 times)
UBAB
Bro
Hero Member
*

Reputation Power: 3
UBAB has no influence :(
Posts: 614


2 [agree] or not 2 [disagree]-that is the question


WWW
« on: Mar 17, 2009 04:46 PM »


Okay - we live in a different world today. The following is a Liability Waiver Form we made parents sign before they can drop off their kids at the Children's Programs at Islamic events. I can't find the original I made in 2002, but this is the current version. It seems harsh, but it has saved the Islamic organizations at least once from parents who are bent on enforcing their will on the organization; it's currently used at RIS, ISNA and MuslimFest conventions in Canada.

Included in this waiver is the right to take pictures, because sometimes news media films the events to brodcast during the evening news. One parent threaten to sue because we didn't get her permission to film her children, until we show her this waiver, then she back off - although she claimed that she didn't read that part.

The bottom line is this, most children programs during conferences or other events are usually staffed by high school girls who get verbal smackdowns from the children's parents whenever anything happens, this was the response to that: basically we will not accept your kids simply because you paid the registration fee, and we have the right to kick out your kid if they misbehave and your giving us that right by signing   Smiley



***


___________Children’s Program 2009

   Release/Indemnification of all Claims and Covenant not to Sue

 

     NOTICE:  THIS IS A LEGALLY BINDING AGREEMENT. By signing this agreement, you give up your right to bring a court action to recover compensation or obtain any other remedy for any injury to you, your family or to your property or for your  or your family members death however caused arising out of your or your family member’s participation of ___________Children’s Program, now or any time in the future.

 

Governing Law: The laws of the Province of Ontario, Canada shall govern this Agreement and its performance. You consent and submit to the exclusive jurisdiction of the courts of the Province of Ontario, Canada, in all disputes arising out of or relating to the use of the___________ Children’s Program and this Agreement.

 

Liability Disclaimer: The ___________Children’s Program, its third party providers and distributors make no representations, warranties, guarantees or conditions of any kind, express or implied, regarding the ___________Children’s Program, or any content or materials provided on the ___________ Children’s Program, or your use of the ___________ Children’s Program or of any services provided through your use of the ___________Children’s Program or otherwise by The ___________ Children’s Program, all of which are provided on an "as is" basis.

 

     I ACKNOWLEDGE AND AGREE that the participation of any program, including participation in the ___________Children’s program has inherent risks. I have full knowledge of the nature and extent of all risks associated with exercising, running, playing, and the ___________Children's program, including but not limited to:

 

GAMES, SONGS, PRAYERS, EXERCISES, INSTRUCTION, IF ANY, AND ANY OTHER ACTIVITY ASSOCIATED WITH THE ___________ CHILDREN’S PROGRAM ON AND AFTER THE DATE HEREOF.

 

I further acknowledge that the above list is not inclusive of all possible risks associated with the program and that the above list in no way limits the extent or reach of this release and covenant not to sue.

 

     In consideration of my child’s participation in the ___________Children's Program program, I, the undersigned user, agree to release, indemnify, and hold harmless, on behalf of myself, my heirs, representatives, executors, administrators, and assigns HEREBY DO RELEASE, INDEMNIFY, AND HOLD HARMLESS ___________ Children's PROGRAM., it  officers, agents, and employees (hereafter collectively referred to as "___________CHILDREN'S PROGRAM") from any cause of action, claims, or demands of any nature whatsoever, including but not limited to, a claim of negligence, which I, my heirs, representatives, executors, administrators, and assigns may now have, or have in the future against ___________ CHILDREN'S PROGRAM, on account of personal injury, property damage, death, or accident of any kind, arising out of or in any way related to my use of the ___________CHILDREN'S PROGRAM facility, whether that use is supervised or unsupervised, however the injury  or damage is caused, including, but not limited to the negligence of ___________CHILDREN'S PROGRAM, its officers agents, and employees.

 

        I hereby certify that my child is in good health and that my child has no physical limitations, which would preclude their safe participation in the ___________ Children program. I further understand that the terms of this agreement are legally binding and I certify that I am signing this agreement, after having read it.

 

I ASSUME ALL RISKS AND HAZARDS TO INCIDENTAL TO THE CONDUCT OF THE ACTIVITIES.

 

I AM THE PARENT OR GUARDIAN OF THE NAMED CHILD WHO IS A CANDIDATE TO BE PARTICIPATING AT THE ___________CHILDREN'S PROGRAM.  I HEREBY GIVE MY APPROVAL TO THE PARTICIPATION IN ANY AND ALL OF THE ACTIVITIES OF THE ___________CHILDREN'S PROGRAM.

 

I give permission for photographs taken at ___________ Children’s Program may be used for publicity purposes.

 

Important !!:

 

Children must stay within sight of instructors at all times. It is imperative that the children behave and obey instructors.   Potential safety hazards will be discussed.  Those whose conduct or influence creates safety or discipline problems will be asked to leave.  They will not receive a refund. Please don’t bring electronic games, toys or other distractions.

 

Date_______   Participant’s  Name_____________________________

 

 

Date of Birth__________ Phone__________________

 

Address ______________________________________

 

City_________________ Province_____ Postal Code__________ Parent or Legal Guardian Signature is Required: ______________________

 

 

AUTHORIZATION FOR MEDICAL SERVICES

 

I/We, parent(s)/guardian(s) of _______________________ (name of child/ward), hereby designate the program leader or his/her designee to act in my behalf to authorize such hospitalization, medical attention, and/or surgery as may be required in an emergency because of illness or injuries sustained by my/our child/ward while participating in___________Children Program activities. I/We hereby assume financial responsibility for hospitalization, medical attention, transportation, and surgery provided. I/We request that I/We be contacted within a reasonable time in the event of illness or injury requiring medical services.

 

 

Emergency contact

Emergency Contact Name:_______________________________________

Emergency Contact number: _____________________________________

Child’s Doctor Name: __________________________________________

Child’s Doctor Phone Number: ____________________________________

Child’s Health Insurance Number: _________________________________ Any Allergies: _________________________________________________

Allergy Alert: Please call ___________ at ______________for more information Any Medication we should be aware of?_____________________________

 

Parent or Legal Guardian Signature is Required: ______________________ Parent or Legal Guardian Name (please print) _________________________

 


Your heart will not truly open until you understand Surah 21 : Verse 92  (Al-Anbiya: The Prophets)

Help Build the Community! Visit:
Madinat al-Muslimeen > The City > Naseeha Corner > Community Toolbox
Sr.Kathy
Sis
Hero Member
*

Reputation Power: 18
Sr.Kathy has no influence :(
Posts: 632



« Reply #1 on: Mar 18, 2009 02:47 PM »

I just love this site... especially for these kind of posts.
Saves me so much work!

"Allah surely knows the warmth of every teardrop... " Jaihoon
UBAB
Bro
Hero Member
*

Reputation Power: 3
UBAB has no influence :(
Posts: 614


2 [agree] or not 2 [disagree]-that is the question


WWW
« Reply #2 on: Mar 18, 2009 04:13 PM »

Lets keep it coming - fyi - we included prayer as a risk because once a kid bumped his forehead going down in sujud too fast   

Your heart will not truly open until you understand Surah 21 : Verse 92  (Al-Anbiya: The Prophets)

Help Build the Community! Visit:
Madinat al-Muslimeen > The City > Naseeha Corner > Community Toolbox
Anonymous
Bro
Sr. Member
*

Reputation Power: 22
Anonymous barely matters :(Anonymous barely matters :(
Posts: 355


ANONYMOUS Post


« Reply #3 on: Sep 12, 2010 03:47 AM »

Hello Smiley

I was doing an internet search for a liability form for a childrens program and found this form on your site.
http://jannah.org/madina/index.php?topic=2619.0;prev_next=prev#new

I appreciate its firmness, clarity and points I had not even considered.  Would it be okay to use the form posted and modify it for our use ?

Can I include credit on our modifed form ?

Thank you

Melissa

This post submitted using the ANONYMOUS button on the main Madina menu. Please reply here publicly so that the original poster can read any replies.
Pages: [1]   Go Up
  Print  
 
Jump to: