INDEMNIFICATION, WAIVER, & INFORMATION FORM
Pop Up Park Buffalo requires that we have documentation verifying that the participant or the parent of the minor participants understands and accepts the following agreement pertaining to Pop Up Park. Please read this document carefully before you sign.
In consideration for receiving permission for my/my child’s permission in any and all activities of Pop Up Park I hereby freely and voluntarily, without duress, execute this agreement under the following terms:
1. Waiver and Release: On behalf of myself and my child, I release, waive discharge, covenant not to sue, and agree to hold harmless for any and all purposes Pop Up Park Buffalo and its staff and volunteers (herein referred to as “PUP”) from any and all liabilities, claims, injuries (including death), damages, and demands, of whatever kind or nature, either in law or in equity including court costs and attorney’s fees and expenses, that may be sustained by me/my child while participating in such activity, or while on the premises owned or leased by PUP, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of PUP.
2. Assumption of Risk: I am fully aware that my/my child’s time with PUP may include activities that may be hazardous including, but not limited to, running, climbing, construction activities, and loading and unloading of equipment and materials. I recognize and understand that my/my child’s time with PUP may, in some situations, involve inherently dangerous activities and I choose to voluntarily participate/allow my child to participate in said activity with full knowledge that the activity may be hazardous to me, my child and my property, and to the person and property of others. I know of no medical reason why I/my child should not participate.
For myself and my child I hereby expressly assume full responsibility and risk of injury, harm or property damage and release PUP from all liability for injury, illness, death or property damage resulting from the activities of myself/my child at Pop Up Park.
3. Medical Treatment: I hereby authorize PUP staff, or in their absence or disability, any adult accompanying or assisting them, to provide and arrange for medical care for a minor in the event of an emergency, where the minor is not accompanied by either parents or legal guardians, and it may not be feasible to contact them. I consent for PUP staff to administer general first aid treatment for any minor injuries or illnesses experienced by the Minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize PUP staff to summon any and all professional emergency personnel to attend, transport, and treat the minor. I agree to assume financial responsibility for all expenses of such care.
On behalf of myself and my child I hereby release and forever discharge PUP from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my/my child’s time with PUP
It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the PUP staff in the exercise of their best judgement upon the advice of any such medical or emergency personnel.
4. Other: It is my express intent that this agreement shall be governed by and interpreted in accordance with the laws of the State of New York. I further expressly agree that the foregoing agreement is intended to be as broad and inclusive as is permitted by the law of the State of New York and that, if any portion thereof is held invalid, it is agrees that the balance shall, notwithstanding, continue in full legal force and effect.
5. Voluntary Signature: In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; PUP has not made and I have not relies on any oral representations, statement, or inducements apart form the terms contained in this agreement. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future. I understand I can choose not to sign this document and free myself and my child from its terms and the associated risks of the activity by simply not participating in Pop Up Park.
MEDIA RELEASE FORM
On behalf of myself and my child(ren) I hereby grant permission to Pop Up Park Buffalo all right, title, and interest in all photographic images and video or audio recordings made by Pop Up Park Buffalo during my/my child(ren)’s participation in Pop Up Park for the purpose of documentation and promotion by Pop Up Park Buffalo for the following, but not limited to: new releases, photographs, video, audio, Pop Up Park Buffalo website and social media sites, marketing, and advertising.
I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown.
I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
Please fill out the following information and bring this form with you on the day of the event.
To help streamline the check-in process on the day of the event, please download this waiver (PDF File), fill out page 3, and bring the form with you to the event. Click below to download: