Del Rio – Self Defense Workshop Form – Community Services Division (CSD)

Del Rio – Self Defense Workshop Form

Defense English

Name of Child(ren)

Age of Child(ren)

Name of Parent/Guardian

Phone

Defense Liability Form English

RELEASE OF LIABILITY AND ASSUMPTION OF RISK

The individual named below (referred to as “I” or “me” or “my”), on behalf of myself and my child(ren), agrees to all the terms and conditions set forth in this agreement (“Agreement”).

I am aware and understand that there are risks associated with this Self Defense Workshop (the “Activity”), including, but not limited to, the possibility of injury and/or death and/or property damage. I acknowledge that participating in the Activity is completely voluntary and I am aware of the risks inherently involved, and I hereby agree to accept and assume any and all risks of injury, death, or property damage, whether caused by the actions, inactions, or negligence of BCFS Health and Human Services ( “Company”), a third party or otherwise.

I hereby expressly an unequivocally waive and release all claims against Company for whatever reason and whenever such claim or claims may arise. This waiver and release of all claims against Company includes its officers, directors, employees, agents, affiliated entities, owners, successors, and assigns (collectively, “Releasees”), for any loss or damages that are attributable to my participation and the participation of my child(ren) in the Activity, whether arising out of the negligence of the Company or any Releasees or otherwise. I, on behalf of myself and my children, covenant not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims.

I shall defend, indemnify, and hold harmless Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney fees, fees and the costs of enforcing any claim brought by a third party who may, or has a right to indemnification under this Agreement.

This Agreement constitutes the entire agreement between Company and me with respect to the subject matter contained herein and supersedes all prior written or oral agreements made or contemplated. In case any provision in this Agreement shall be deemed invalid, illegal, or unenforceable, the validity, legality, and enforceability of the remaining provisions shall not in any way be affected or impaired thereby and such provision shall be ineffective only to the

extent of such invalidity, illegality or unenforceability. This Agreement is binding and shall inure to the benefit of Company and me and their respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the laws of the State of Texas without giving effect to any choice or conflict of law. Any claim or cause of action arising under this Agreement shall be brought only in the federal and state courts located in Bexar County, Texas, and I hereby consent to the exclusive jurisdiction of such courts.

By signing, I acknowledge that I have read and understood all the terms in this Agreement.

I further confirm that I am the parent or legal guardian of the minor child(ren) named below. I have the legal right to consent to this Agreement and by signing below, I hereby do consent to the terms and conditions of this Agreement on his, her, or their behalf.

Printed Name of Parent/Legal Guardian

Date

By signing, I acknowledge that I have read and understood all the terms in this Agreement. I further confirm that I am the parent or legal guardian of the minor child(ren) named below. I have the legal right to consent to this Agreement and by signing below, I hereby do consent to the terms and conditions of this Agreement on his, her, or their behalf.

Authorization To Take and Use Photographs and Waiver and Release of Claims

Authorization To Take and Use Photographs and Waiver and Release of Claims

• I irrevocably authorize the BCFS Health and Human Services (“Company”) and its affiliated entities to use, display, publish, and distribute photographs of my image and likeness for purposes they consider appropriate on websites, publications, broadcasts, displays, and any other visual medium, and to share these images with organizations or individuals beyond Company to be used in ways which those third parties consider appropriate.

• I understand Company will own any pictures they take, including those that feature me.

• I waive any right to inspect or approve these images or any material that may be used with them now or in the future, whether that use is known to me or not. I understand that should I have an issue with how my image or likeness is used, it is my right to attempt contact with Company to request the image be removed or altered. Though Company is not obligated to make a change to any photograph or accompanying material based on my requests, I understand they may be able to make changes based on my requests if such a change is possible.

• I hereby release Company and its affiliated entities as well as its directors, officers, employees, and agents (collectively “Releasees”) from all liability arising out of the use of photographs of my image or likeness, including, but not limited to, any claims arising out of my right of privacy or right of publicity, and any claims based on any unintentional distortions, optical illusions, or faulty mechanical reproductions.

• I understand that I will not be compensated for any use of these photographs.

• I verify that I am at least 18 years of age, or that I am the legal guardian of the individual(s) being photographed.

• I understand that this is a legal document, and that by signing below, I represent I have completely read and fully comprehend this document’s contents. I recognize that I am signing it voluntarily.

By Checking, I hereby authorize the use of my photographs.

Name of Child

Date

If under age 18, a parent or guardian must complete the following:

Parent/Guardian Name

Date

Relationship

Phone Number

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