Waiver of Liability and Media Release

Waiver of Liability and Media Release must be completed by each participant

Event Name: Playworks Minnesota – We Play Together
Event Date: 10/27/2018

I consent to be photographed and videotaped while participating in Playworks We Play Together event. I agree that this program material may be edited as desired, duplicated and used in whole or in part throughout the United Stated and abroad. I consent to the use of my name, likeness, voice, and biographical material for program publicity and institutional promotional purposes (including, but not limited to newspaper articles with photos, press releases for Playworks events, promotional videos representing the organization, photos for the Playworks website and social media properties, photos for archival records and documentation for funders). By signing this form, I expressly release Playworks, its licensees and assignees, from any claims I may otherwise have arising out of broadcast, exhibition, publication or promotion of this program material.

I hereby attest that I am fully cognizant of the risks involved in participating in any activities during We Play Together. I further attest that I do not suffer from any heart, lung or other medical condition or disease that might in any way hinder or prevent me from participating in these activities. In consideration of my participation in We Play Together, I hereby release, discharge and hold harmless Playworks and its officers, directors, employees, members, subsidiaries, agents, successors, and assigns from any and all liability that may arise, directly or indirectly, now or in the future, by reason of any injury, damage, loss, or expense incurred in connection with my participation in We Play Together, including that caused solely or in part by the fault (including but not limited to negligence, gross negligence, and/or recklessness) of the above-named parties. This Release and Waiver of Liability shall be binding on my heirs, executors, administrators, successors, and assigns. I further attest that I have adequate health coverage to handle any injury that may occur during Playworks We Play Together.

Each child must be accompanied and supervised by an adult at all times.