JLBC – JUNIOR LEADERSHIP BOOTCAMP – AGREEMENT AND LEGAL WAIVERFORM
AGREEMENT AND LEGAL WAIVER
I declare that all statements on this enrollment form and attachments are true and complete to the best of my knowledge. I understand that false, misleading, or incomplete information shall be cause for disqualification or termination from the JLBC – Junior Leadership Bootcamp program(hereinafter “Cadets Program”). I understand that my participation in the Cadets Program is voluntary and at an “at will” status; and that the sponsoring agency/organization, acting through its Cadets ProgramUnit, is free to discharge me without causeand I am free to discontinue participation in the program at any time. I understand the importance of providing accurate medical information, I certify that all information provided is accurate, and I acknowledge that there are no undisclosed physical limitations that would prevent me from participating in all aspects of the Cadets Program. I understand that participation in the Cadets Program involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges of the CadetProgram activities. I agree that approved Mentorsand program volunteers may provide transport during Cadets Program activities. I also understand that in the event of serious illness or injury, reasonable efforts will be made to contact the parent or guardian, if listed below.
AGREEMENT ASSUMING RISK OF INJURYOR DAMAGE, WAIVERAND RELEASE OF CLAIMS
With appreciation of the dangers and risksassociated with the Cadets Program,I hereby release,acquit and foreverdischarge the JLBC – Junior Leadership Bootcamp, the partnering agency/organization and its officers, agencies, and employees of and from any and all rights, claims, demands, actions, causes of action,damages, costs, lossesof services, compensation, and debts, including attorney’s fees (collectively “claims”) which I may have against the Cadets Program, whether known or unknown, which result from, arise from, or are related in any way to my participation in the Cadets Program or any activities or events related thereto. I hereby agree to hold harmless JLBC – Junior Leadership Bootcamp and the partnering agency/organization from and against any and all claims which result from, arise from, or are related in any way to my participation in the Cadets Program excluding only claims that are attributable to the gross negligence or willful misconduct of JLBC Junior Leadership Bootcamps and/or the partnering agency/organization.
Should I require emergency medical care while participating in the Cadet Program, I hereby give sponsoring agency/organization personnel my permission to use their judgment in obtaining care for me and I give permission to the medical care provider selected by the Cadet Program personnel to render medical care deemed necessary and appropriate. Such consent includes any x-ray examination, anesthetic, medical or surgical diagnostic or treatment and/or hospital service that may be rendered. I understand that JLBC – Junior Leadership Bootcamp or the sponsoring agency/organization is not obligated to provide medical treatment and that any cost incurred for treatment provided which is not covered by insurance shall be my sole responsibility. I warrant that I understand the content of the foregoing authorization and release.My signature, hereon,is my own free act and it is my intention to be legally bound hereby.
WAIVER FOR CONSENTFOR PHOTOGRAPHS
I do herebyconsent to beingphotographed, by professional and/or amateur photographers, while participating in any detail, event, function, or activity related to the Cadets Program. I also give my consent for the JLBC Junior Leadership Bootcamp and/or the partnering agency/organization, including any Division or unit therein to use my name, likeness, image, appearance, and biographical information (“Image”), in, on or in connection with any photographs, pictures, digital images, websites programs, printed materials and any and all media, whether now known or hereafter developed, throughout the world at any time,for the legitimate purposes of JLBC – Junior Leadership Bootcamp. I hereby expressly waive all claimsfor royalties or other compensation related to any such use of my Image or related information and release JLBC – Junior Leadership Bootcamp and the partnering agency/organization from anyand all liability which may ariseas a result of being photographed while participating in the Cadets Program, and for the subsequent use and display of theImage. I understand that this consent/waiver and release will remainin effect until such time that it is revoked, in writing, by me. JLBC – Junior Leadership Bootcamp and the sponsoring agency/organization retains the right to use the aforementioned Image for the purposes stated herein, whether or not I continue to be involved in the Cadets Program, absent my written revocation of consent.
I understand that JLBC- Junior Leadership Bootcamp shall have no obligation to use the Image, and that all creative decisionsregarding the use of the Image shall be at the sole discretion of JLBC – Junior Leadership Bootcamp or the sponsoring agency/organization.
By signingbelow, all Cadet Applicants, Parents,Guardians, Partnering Agency/Organization Unit Mentors have read, understand, and agree to all conditions listed herein.
I acknowledge and agree that this Release& Waiver is binding upon me, my heirs, assignsand legal representatives:
Cadet Signature: Date:
Cadet Printed Name:
If participant is a minor child, I, as his/herparent/legal guardian, agree on his/herbehalf:
Parent/Guardian Signature: Date:
Print Name:
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