Minor Program Waiver

Terms of Service(Required)

I hereby give my approval for the above-named child to participate in a City of Lake Worth Beach Leisure Services Program (hereinafter, “Program”) and agree to the terms and conditions of this Waiver, Release, Indemnification and Hold Harmless and Acknowledgement of Risks Relating to Coronavirus/COVID-19; Emergency Treatment Authorization; and Photo Consent (collectively, “Release”). I acknowledge and fully understand that my child will be engaging in activities that involve risk of serious injury including permanent disability and death. Furthermore, there may be other risks not known or not reasonably foreseeable at this time. I assume all incidental risks and hazards to such participation.

1. Waiver, Release, Indemnification and Hold Harmless. I hereby waive, release, covenant not to sue, and agree to indemnify and hold harmless, the City of Lake Worth Beach and their respective employees, officials, contractors, representatives and volunteers (the “Released Parties”) from any injuries, damages, omissions, commissions, actions, causes of action, claims, suits, judgments and damages accruing, including court costs and attorney’s fees at all levels of trial and appeal, that I or my child have or may have, arising out of an injury, illness, death, first aid treatment or other medical services rendered in connection with participation, or loss or damage to the person or property of my child while participating in this Program even if arising out of the negligence, in whole or in part, action or inaction of the Released Parties (collectively, “Claims”). I understand accident insurance is not provided by the City of Lake Worth Beach for my child while participating in this Program. This Release is meant to include all risks that may arise, inherent and otherwise, known and unknown and is meant to include risks related to the Coronavirus/COVID-19 as described below. Nothing contained in this Release shall be construed as consent by the Released Parties to be sued or as a waiver beyond the limitations set forth in section 768.28, Florida Statutes, as amended from time to time.

2. Acknowledgement of Risks Relating to Coronoavirus/COVID-19. I acknowledge that on or about March 11, 2020, Coronavirus Disease 2019 (“COVID-19”) was declared a pandemic by the World Health Organization. The Centers for Disease Control and Prevention has stated that “the best way to prevent illness is to avoid being exposed to this virus” (see: https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html). I am aware of the contagious nature of COVID-19 and have voluntarily chosen to allow my child to participate in the Program. I acknowledge that the Released Parties come into contact with multiple individuals and might become exposed to COVID-19. I also acknowledge that although the City may take precautions to reduce the likelihood of transmission of COVID-19 by the Released Parties, the City cannot guarantee that my child will not become infected with COVID-19. I acknowledge that by allowing my child to participate in the Program, I am exposing my child and myself to the risk of becoming infected with COVID-19, which may result in serious personal injury, illness, permanent disability and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from actions, negligence and failures to act committed by myself and others, including, but not limited to the Released Parties and other Program participants and parents. In consideration for my child’s participation in the Program, I agree to assume all of the foregoing risks, and accept personal responsibility for any injury to my child or myself, including, but not limited to, personal injury, disability and death, illness, damage, loss, claim, liability or expense, of any kind or nature, that I or my child may suffer arising out of or in connection with my child or myself becoming exposed to or infected by COVID-19 while my child is participating in the Program. On my own behalf and on behalf of my child, I hereby release, covenant not to sue, and forever discharge the Released Parties of and from all Claims arising out of or in any way connected with my child or myself becoming exposed to or infected by COVID-19. I understand that this release includes any Claims ARISING DIRECTLY OR INDIRECTLY OUT OF THE NEGLIGENCE (ACTION OR INACTION), IN WHOLE OR IN PART, OF THE RELEASED PARTIES and covers bodily injury (including death) due directly or indirectly to COVID-19, whether a COVID-19 infection occurs before, during or after participation in the Program.
3. Emergency Treatment. In the event of any emergency, I hereby authorize first aid treatment or other medical services (including required transportation) for my child in connection with an emergency during my child’s participation in the Program. I understand that I will be responsible for all charges incurred for emergency transportation and emergency care.

4. Photo Consent. I hereby authorize the City (or its designee) to take photographs, videos and audio recordings of my child while he/she is participating in the Program, and I hereby grant the City all rights and interests in all such photographic images, videos and recordings. I consent to and authorize the use/reproduction of the photographs, video and audio of my child without compensation, and I agree that all negatives, positives, and prints shall be the sole property of the City.

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Parent / Guardian Name(Required)
Childs Name(Required)
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