Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Participation Agreement and Waiver *
SPARKS PARTICIPATION AGREEMENT, RELEASE and WAIVER, by and between Sparks, a division of Chabad Lubavitch of the West Side, Inc. and parties signed electronically below ("Parent's Name") residing at address noted below ("Parent's Address"), on behalf of his/her child (field: "Child's Name" above), (collectively, "Participant"). By registering for classes, programs and activities with, and administered by or on behalf of, Sparks, for good and valuable consideration the receipt of which is hereby acknowledged, Participant hereby agrees to the following: As parent/legal guardian of participating child, I/we enroll him/her in applicable session(s), agree to be present at all times that our child is (and, inter alia, if my/our child has an allergy that could reasonably require use of a EpiPen Epinephrine Injector, I/we will have it with us and available for use), are fully aware of the risks and benefits of physical activity and represent and warrant that my/our child, and I/we and any and all family participating, are in adequate condition to play and participate, and agree to notify the staff of Sparks, and/or its applicable parent, subsidiaries, affiliates, officers, directors, representatives, employees and agents (collectively, "CLWS") of any health or safety issues so that it can best care for us in the event of an emergency, G-d forbid. Notwithstanding the foregoing, however, I/we recognize that CLWS does not maintain on-site medical staff and may not be equipped to provide emergency or other medical treatment, and I/we agree that CLWS may, in its sole, reasonable discretion, contact external emergency medical care if ever needed. In consideration of my/our child being permitted to participate in CLWS-administered activities, I/we, as parent(s) or legal guardian(s), fully recognize, acknowledge and agree that I/we understand and fully appreciate the risk of injury involved and hereby release, waive, discharge, defend, indemnify and hold harmless from all liability for any cost(s), loss(es), expense(s), demand(s), damage(s) and/or claim(s) (including, without limitation, in the event of injury and/or negligence, and attorney's fees) CLWS and its premises owners and operators (collectively, "Releasees") where activities occur. It is my/our express intention to exempt and relieve the Releasees from any liability, including, without limitation, for personal injury, property damage and/or wrongful death arising from my/our negligence or otherwise pertaining to our participation. I/we hereby authorize CLWS to photograph or otherwise record Participant's name, image, likeness and oral and written statements (collectively, "Likeness") to reproduce and use, in CLWS's reasonable discretion, works made by or on behalf of CLWS, including, in connection with advertisements and other items intended for purposes of CLWS's promotion. Participant, for his/herself, heirs or personal representatives, do hereby agree and hold harmless and release, waive, discharge from liability and covenant not to sue CLWS for any and all liability, personal injury, death, or other accident, illness, property loss or damages, and/or from any and all other claims (including negligence) arising from any participation in the activities or otherwise. Participant hereby releases CLWS from, and shall neither sue nor bring any proceeding against CLWS for, any liability, loss, demands, claims or causes of action in connection with any participation in the activities or otherwise. Participant hereby waives any protections afforded by applicable statute or law in any jurisdiction whose purpose, substance and/or effect is to provide that a general release shall not extend to claims, material or otherwise which the person giving the release does not know or suspect to exist at the time of executing the release. Participant agrees to indemnify, defend and hold CLWS harmless from and against any and all losses, damages, liabilities, penalties, costs of settlement and expenses (including, without limitation, reasonable attorney's fees and expenses) arising from any third-party claims, suits, proceedings, demands or causes of action (including, without limitation, governmental actions) arising out of, resulting from or relating to Participant's involvement as contemplated herein. IN NO EVENT SHALL CLWS BE LIABLE FOR ANY SPECIAL, INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES (INCLUDING, WITHOUT LIMITATION, FOR BREACH OF CONTRACT, WARRANTY, NEGLIGENCE OR STRICT LIABILITY), LOSS OF USE, LOST BUSINESS, OR LOST PROFITS, ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT. FURTHER, UNDER NO CIRCUMSTANCES SHALL CLWS BE LIABLE FOR AN AMOUNT GREATER THAN THE AMOUNTS PAID BY PARTICIPANT IN CONNECTION WITH THE ACTIVITIES CONTEMPLATED HEREIN REGARDLESS OF THE CAUSE OF ACTION. THIS LIMITATION IS MATERIAL TO THIS AGREEMENT AND IT IS EXPRESSLY UNDERSTOOD THAT CLWS WOULD NOT HAVE ENTERED INTO THIS AGREEMENT WITHOUT SUCH LIMITATIONS. The parties expressly agree that all the terms and provisions hereof shall be construed in accordance with and governed by the laws of the State of New York. The parties hereby agree that any dispute between them arising out of or in connection herewith shall be resolved through binding individual (not class) arbitration via Arbitration Resolution Services, Inc. ("ARS"), or if ARS is unavailable, adjudicated before a court located in New York, NY and irrevocably waive any objection they now or hereafter may have respecting the venue of any such action or proceeding. Participant hereby represents that he/she has read the foregoing and fully understand the meaning and effect thereof, and, intending to be legally bound, has signed, but understands that he/she may be giving up substantial rights, including the right to sue, yet acknowledge that he/she is signing freely and voluntarily, intending such signature to be a complete and unconditional release of all liability to the greatest extent allowed by law, expressly agreeing that this is intended to be as broad and inclusive as is permitted by law and that if any portion hereof is held to be invalid, he/she agrees that the balance shall, notwithstanding, continue in full legal force and effect. Participant, on behalf of his/her minor, as parent/legal guardian, as required by law, hereby agrees to all of the terms hereof, specifically waiving any claim or any defense to the full enforcement of this agreement based on age or incompetency or the lack of independent, competent or experienced legal representation. IN WITNESS WHEREOF, the parties hereto have duly executed and delivered this agreement as of the date and year first set forth above.
Name of Parent/Legal Guardian *
Name of Parent/Legal Guardian
Address of Parent/Legal Guardian *
Address of Parent/Legal Guardian
Daytime Phone *
Daytime Phone
Evening Phone *
Evening Phone
Relationship to Child - I do hereby attest that I am the parent or legal guardian of the above named minor child, and have the legal authority to sign this agreement on his or her behalf. I have read and fully understand and agree to the complete contents and implications of this document. *