Homework Club

Name of Child *

First Name

Last Name

Name of Parent or Guardian *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PHOTO/VIDEO/AUDIO Release *

I hereby give permission for images of my child, captured during Greenhouse Project Club & Programs and Events through video, photo, audio and digital camera, to be used solely for the purposes of Greenhouse Project promotional material and publications, and waive any rights of compensation or ownership thereto.

YES

NO

GHP Homework Club Authorization and Waiver

IT IS THE PURPOSE OF THIS AGREEMENT to exempt, waive and relieve releases from liability for personal injury, property damage, and wrongful death, including if caused by negligence, including the negligence, if any, of releases. ‘‘Releasees’’ include Greenhouse Project, its affiliate associations, other participants, coaches, officials, sponsors, advertisers, owners and operators of the premises used to conduct any event and each of them, their officers, directors, agents and employees. Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge that they have been provided and have read the below paragraphs and have not relied upon any representations of releases, that they are fully advised of the potential dangers of club activities and understand these waivers and releases are necessary to allow club activities to exist in its present form. IT IS AGREED that for and in consideration of the right and permission to participate in club activities at Greenhouse Project, that the undersigned, for itself, its successors, assigns, officers, directors, agents and employees, hereby, release, remise and forever hold Greenhouse Project, its successors assigns, agents, employees and all other persons, firms or corporations, who are or might be liable in any way, from any and all liability or responsibility whatsoever of any kind and nature, arising from, and by reason of said participation. IT IS FURTHERMORE AGREED that Greenhouse Project will oversee and be solely responsible for upholding the rules and duties of each club as set forth by Greenhouse Project. The undersigned do further agree to indemnify and hold harmless any and all Greenhouse Project volunteers and employees and the other above named individuals from any such claims asserted. The undersigned have read the foregoing Waiver and understand the same fully and sign the same as my voluntary act and deed.

I Agree