WAIVER AND RELEASE OF LIABILITY FORM
The undersigned is the Parent and/or Guardian of the minor child whose name is listed below (the “Participant”). The undersigned has signed up for the Participant to participate in an after-school ping pong related class/programs (the “Program”) in the Summer and/or Fall at the PingPod location in Williamsburgh, Brooklyn (the “PingPod Location”). By signing below, and in consideration of the Participant being allowed to participate in the Program, the undersigned for his/herself and on behalf of the Participant:
Hereby assumes all of the risks of the Participant participating in any activities associated with the Program, including by way of example and not limitation, any risks that may arise from (i) negligence or carelessness on the part of Pingpod Inc., its affiliates, officers, directors and employees (“Pingpod Parties”), (ii) dangerous or defective equipment or property owned, maintained, or controlled by any of the Pingpod Parties and (iii) from actions or conduct of other participants in the Program.
Certifies (i) that Participant is physically fit and has not been advised to not participate by a qualified medical professional and (ii) that there are no health-related reasons or problems which preclude Participant’s participation in the Program.
Agrees to be responsible for any damages, claims, or liabilities arising out of the Participant’s conduct or actions during the Program.
Agrees that the Participant will follow all rules established by the Pingpod Parties for conduct during the Program and acknowledges that the Pingpod Parties may revoke the Participant’s right to participate in the Program for not following such rules, or for any other basis in the Pingpod Parties’ determination
Understands that while participating in this activity, Participant may be photographed or videotaped. Unless permission is revoked, such photo, video, or film likeness may be used for any legitimate business purpose by Pingpod. Inc.
The undersigned has the choice of arranging for Participant to travel the distance from Jose De Diego school (the “School Location”) or such other location from which Participant will be traveling to the PingPod Location. Alternatively, a PingPod staff member will be walking from the School Location, after school ends, to the PingPod location, and the undersigned may with advance written notice to PingPod choose to permit the Participant to walk with the staff member, and other children whose Parent/Guardian avail themselves of this option, to the PingPod Location (the “Walking Option”). The undersigned, for his or herself, and on behalf of the Participant acknowledges the risks of the Walking Option and nonetheless agrees to utilize the Walking Option if advance written notice is given to PingPod. Further, the undersigned, on his/her behalf and on behalf of the Participant, waives, releases and discharges the Pingpod Parties and any staff member involved in the Walking Option from any and all liability, claims or damages including but not limited to, liability arising from the negligence or fault of the Pingpod Parties and/or any staff member involved in the Walking Option, for Participant’s personal injury, disability or death, or any property damage, property theft, or damages of any other kind which may hereafter occur to the Participant arising out of or relating to participation in the Walking Option. It is the responsibility of the undersigned whose child is using the Walking Option to make sure that the Participant is available on time to exercise the Walking Option, and to notify PingPod in advance of any absence or inability to utilize the Walking Option on any particular day. The PingPod Parties and any staff member involved in the Walking Option shall have no responsibility for any failure of any Participant to be available at the required time, to utilize the Walking Option.
I certify that I have read this document and I fully understand its content. I am aware that this is a release of liability and a contract and I sign it of my own free will.