Fill and Sign the Parent Guardian Form

Waiver and Release by Parent or Guardian and Minor Child from Liability Resulting from Instruction in Infant Massage Agreement made on the _________________________ (date) , between ___________________________ (Name of Parent or Guardian) of ______________________ _______________________________________________ (street address, city, state, zip code) , referred to herein as Caregiver , and ___________________________ (Name of Instructor) , of ______________________________________________________________________________ (street address, city, state, zip code), referred to herein as Instructor . Whereas, Instructor teaches classes in infant massage to Caregivers who perform these massage techniques on their babies in a classroom setting and at the homes of said Caregivers; and Whereas, said classes are taught in groups and in private lessons; and Whereas, the goal of these classes (hereinafter sometimes referred to as the Program ) is to teach the Caregiver a full body massage routine based on Indian and Swedish massage techniques, reflexology and yoga in order to learn how to calm and soothe their baby through nurturing touch; and Whereas, it is a condition to being accepted into the Program that Caregivers execute this Waiver and Release after having read it and had it explained to him/her by the person of their choice; and Whereas, Caregiver desires to participate in said Program with Caregiver’s child __________________________ (name of child), hereinafter referred to as Child ; Now, therefore, for and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Caregiver does hereby waive, release, and agrees to indemnify and hold harmless Instructor and Instructor’s Employer ______________________________ (name of Employer) of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that Caregiver or Child ever had or may have, arising from or in any way related to the participation of Caregiver or Child in the Program , provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct of Instructor. 2. This waiver and release includes (but is not limited to) any injuries to Child resulting from Child’s participation in any aspect of the Program as well as any injuries resulting from the practicing by Caregiver of these massage techniques outside of the supervision of Instructor. 3. On behalf of the undersigned Caregiver, the Child, and the heirs, assigns and next of kin of Caregiver and Child, the undersigned Caregiver waives all claims for damages, injuries and death sustained by said Child that result from my practice of said massage techniques. 4. The undersigned Caregiver certifies that Child is in good physical condition and has no physical impairment or injury that would worsen as a result of participation in the Program. 5. This Agreement contains the entire agreement between the parties, and supersedes any prior written or oral agreements concerning the subject matter of the Agreement. The provisions of this Agreement may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties. 6. The provision of this Agreement will continue in full force and effect even after the termination of the Program, whether by agreement, by operation of law, or otherwise. 7, Caregiver has read, understands and fully agrees to the terms of this Agreement, and confirms that, by signing this Agreement, Caregiver may have given up considerable future legal rights. Caregiver has signed this Agreement freely, voluntarily, under no duress or threat of duress, and without inducement, promise or guarantee being communicated to Caregover . The signature of Caregiver is proof of his/her intention to execute a complete and unconditional Waiver and Release of all liability to the full extent of the law. WITNESS my signature on the ______ day of _______________________, 20_____. _____________________________ Name of Child _____________________________ By: ___________________________ Signature of Parent (Guardian) Signature of Parent (Guardian)