In consideration for being granted opportunity to participate in the above activity, I, for my child, myself, my executors, administrators, heirs and assigns, agree forever to RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE D. Evan Kanouse DVM PC DBA Brook Farm Veterinary Center, its Board of Trustees, officers, employees, agents, contractors, or volunteers (collectively referred to as “Released Parties”), for any and all personal injuries, death, loss of or damage to property, or any other damages whatsoever, from whatever cause, supervised or unsupervised, including but not limited to negligence, resulting from my participation in the above activities of D. Evan Kanouse DVM PC DBA Brook Farm Veterinary Center (“Brook Farm” or “Brook Farm Veterinary Center”), including any transportation to and from any such activities.
I UNDERSTAND AND AGREE THAT MY OR MY CHILD’S PARTICIPATION IN THE ACTIVITY IS VOLUNTARY. I FURTHER UNDERSTAND AND AGREE THAT PARTICIPATION IN THE ACTIVITY IS AT MY OR MY CHILD’S OWN RISK AND THAT BROOK FARM IS NOT RESPONSIBLE FOR ANY INCIDENTS, INJURIES OR LOSS OF PROPERTY THAT MAY OCCUR.
I understand that my child may be photographed or videotaped while at Brook Farm. I give my consent and permission for both internal and external use of photographs or videos of my child for public relations, news articles or telecasts, education, advertising, research, inclusion on Brook Farm’s website, fundraising or any other purpose by Brook Farm and/or its affiliates and hereby waive any rights of compensation for such use. I agree that all negatives and positives, whether prints, video, film or data file, are the property solely of Brook Farm, or the individual or entity designated by it.
I HAVE CAREFULLY READ THIS ENTIRE RELEASE, WAIVER OF LIABILITY, EMERGENCY MEDICAL AUTHORIZATION, AND CONSENT FORM AND I FULLY UNDERSTAND ITS CONTENTS. I HAVE SIGNED THIS FORM OF MY OWN FREE WILL AND I AGREE TO BE LEGALLY BOUND BY IT.
In consideration of my child being permitted by Brook Farm Veterinary Center to use its facilities and/or participate in any activity offered by Brook Farm, I, for my child, myself and our respective executors, heirs, assigns and administrators agree to the entirety of the release above. I represent and certify that my true age is at least 18 years old and that I have authority to execute this document on behalf of my child/guardian.