Please initial on the line preceding each paragraph to acknowledge consent. Kids Place Northwest is a non profit educational organization incorporated in the State of Washington. Kids Place Northwest provides instruction in culinary arts (cooking), arts, crafts, gardening, music and other instruction for children and youth.
______ I acknowledge that my child will be using sharp instruments (knives and other cooking equipment, gardening equipment, other equipment) and have access to heat sources (ovens, stoves, other cooking equipment, glue guns) and may come into contact with food allergens and other allergens as part of their participation in the class offered by Kids Place Northwest.
______ In consideration of my child being permitted to participate in private cooking and/or art/crafting and/or gardening and/or music and/or other class(es), I hereby waive, release and discharge any and all claims for damages or personal injury, death, or property damage which my child may have or which may hereafter accrue as a result of my child’s participation in said activity. This release is intended to discharge, in advance, Stephanie A. Johnson King, Kids Place Northwest, its officers, directors, members and managers, vendors, venues included but not limited to Marion Grange Hall and Orting United Methodist Church, and all other members of its cooking school staff whether contracted or employed, from and against any and all liability arising out of or connected to in any way with any participation in said activity.
______ I understand that the activity that my child is participating in may be of a hazardous nature and/or include physical and/or strenuous activity, that serious accidents occasionally occur during the said activity; and that participants in the said activity can occasionally sustain personal injuries as a consequence thereof. Knowing the risks involved, nevertheless, I have voluntarily applied to allow my child to participate in said activity, and I hereby agree to assume any and all risks of injury or death and to release and hold harmless Stephanie A. Johnson King, Kids Place Northwest, its officers, directors, members and managers, vendors, venues included but not limited to Marion Grange Hall and Orting United Methodist Church, and all other members of its cooking school staff whether contracted or employed, who might otherwise be liable to me. I further understand and agree that this Waiver, release and assumption of risks is to be binding on my child, myself, my heirs and assigns.
______ I hereby grant Stephanie A. Johnson King, Kids Place Northwest, Marion Grange Hall and Orting United Methodist Church, all rights and consent to copyright, use, re-use, publish or re-publish, copy, exhibit or distribute all photographs and/or video of my child to be used for Kids Place Northwest, Marion Grange Hall and Orting United Methodist Church, website(s), social media and any educational, training or promotional electronic or printed material without restriction as to frequency or duration of usage and without compensation. In consideration for your participation in an event by Kids Place Northwest and/or Stephanie A. Johnson King (instructor), and by signing this form, you acknowledge, agree and understand that your child’s participation is voluntary and you assume risks associated with the activity in which your child will be participating.
______ FOOD ALLERGIES AND SENSITIVITIES: Please contact us at least one week in advance if your child has food allergies or sensitivities. You are responsible for advising us of the type and severity of your child’s condition. We will try to accommodate your child to the best of our ability, but please understand that menus are prepared in advance, and last-minute changes are generally not accommodated. Reactions due to food allergies and sensitivities are included as risks associated with culinary (cooking) and gardening classes. By signing this Waiver, I acknowledge that I have carefully read this two page Hold Harmless Agreement, Waiver and Release and fully understand its contents. I am aware that this is a release of liability and a contract between myself on behalf of my child and Kids Place Northwest and any staff member of the cooking class(es) whether contracted or employed.
Print Student’s(s’s) Name(s)___________________________________________________________________
Print Legal Guardian’s Name_______________________________________________________
Guardian’s Email___________________________________________ Guardian’s Phone___________________________________________ Guardian’s Signature_________________________________________________Date________________
Does the participant have any allergies? Y / N If yes, please list_______________________________________________________________ Anything else that would require additional support from us? ____________________________________________________________________________ _
Emergency Contact Name________________________________________________________
Emergency Contact Telephone __________________________
Who else is allowed to pick up your child(ren) from our events? ______________________________________________________________ Name & Phone