S.P.I.N. Waiver of Liability, Indemnification, Medical Release, and Photo Release Authorization

To be signed by adults and parents for their child/children participating in the event.

Acknowledgment and Assumption of Risk I am aware of the dangers and the risks to my person and property involved in participating in: ______________________________________________

I understand that this activity involves certain risks for physical injury. I also understand that there are potential risks of which I may not presently be aware. Because of the dangers of participating in this activity, I recognize the importance and agree to fully comply with the applicable laws, policies, rules and regulations, and any supervisor’s instructions regarding participation in this activity.

I understand that the Stem Path Innovation Network (S.P.I.N.) does not insure participants in the above-described activity, that any coverage would be through personal insurance, and the S.P.I.N. has no responsibility or liability for injury resulting from this activity 

I voluntarily elect to participate in this activity with knowledge of the danger involved, and I hereby agree to accept and assume any and all risks of property damage, personal injury, or death.

Waiver of Liability and Indemnification:

In consideration for being allowed to voluntarily participate in the above-referenced event, on behalf of myself, my personal representatives, heirs, next of kin, successors and assigns, I forever:

A. waive, release, and discharge S.P.I.N. and its agencies, officers, and employees from any and all negligence and liability for my death, disability, personal injury, property damages, property theft or claims of any nature which may hereafter accrue to me, and my estate as a direct or indirect result of my participation in the above referenced activity or event; and 

B. b. defend, indemnify, and hold harmless S.P.I.N., its agencies, officers and employees, from and against any and all claims of any nature including all costs, expenses and attorneys’ fees, which in any manner result from participant’s actions during this activity or event.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident or illness during this activity or event. This release, indemnification, and waiver shall be construed broadly to provide a release, indemnification, and waiver to the maximum extent permissible under applicable law.

I, the undersigned participant, affirm that I am at least 18 years of age and am freely signing this agreement. I have read this form and fully understand that by signing this form I am giving up legal rights and/or remedies which may otherwise be available to me regarding any losses I may sustain as a result of my participation. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect.

Photo Release Authorization:

I grant to S.P.I.N.; its representatives and employees the right to take photographs of me and my property in connection 

with the above-identified subject. I authorize S.P.I.N., its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that S.P.I.N. may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I am the parent or guardian of the minor whose name appears above. I consent to the above terms on his/her behalf, and warrant that I have the authority to give such consent.

Participant's Name *
Participant's Name
Parent or Guardian's Name *
Parent or Guardian's Name
Address *
Address
ELECTRONIC SIGNATURE OF PARENT OR GUARDIAN *
ELECTRONIC SIGNATURE OF PARENT OR GUARDIAN
Date *
Date