Parent Agreement, Waiver and Media Release "*" indicates required fields Parent Name* First Last Phone*Email* 2nd Parent Name First Last 2nd Parent Phone2nd Parent Email Child Info*NameGenderBirthdayMedical Issues (if any) Add RemoveAdditional Persons Authorized for Pick-upNamePhoneEmailRelationship Add RemoveEmergency Contact Name* First Last Relationship*GrandparentBabysitterFamily FriendTeacherOtherPhone*Consent* I agree to the Terms and ConditionsTerms and Conditions of agreement: As the lawful parent(s) and/or guardian(s) of the child (“Child”) named above (collectively, “Parent”), I/We grant permission for him/her to participate in the curriculum and/or activity (collectively the “Program”) and in all events related to and required by the Program offered by AoE Esports, LLC., and its directors, officers, employees, agents, and authorized personnel (collectively the “Provider(s)”). I/Parent enter into this agreement (“Agreement”) voluntarily after reading the information below. I. Services Provided. In exchange for the payment(s), assumptions of risk, releases of liability, and/or waivers of liability described below, Provider agrees to provide the following Program(s) to Child, in accordance with the dates and times evidenced therewith: an esports competitive gaming league for children ages 7 to 18. Provider reserves the right to dismiss any Child that acts with conduct in violation of the Program and Provider’s direction and rules of conduct. Grounds for dismissal shall be for reasonable cause, as determined in the sole discretion of Provider, and such dismissal shall not relieve Parent of any duties or payment obligations thereafter or entitle Parent to any refund. Each participant agrees to abide by the Program rules of conduct and to be courteous and respectful of other participants and instructors. Provider reserves the right, in its sole and absolute discretion, to immediately dismiss, refuse or discontinue services if a Child or Parent: (a) Engages in conduct that Provider deems to be a violation of the Program and/or the rules of conduct displayed in the center, as amended from time-to-time; (b) Exhibits behavior that is disruptive, uncooperative, unsafe, defiant, or dismissive of instruction given by any person in authority; (c) Uses harsh, offensive or threatening language or engages in threatening behavior; and/or, (d) Poses a threat to self, staff or other participants. I/Parent acknowledge(s) that class and program space is limited, and that Provider will suffer harm if my Child is dismissed from the Program for any reason above, or for other reasonable cause. I hereby acknowledge and agree that I will be responsible for transportation and related costs if my Child is dismissed. Further, I/Parent will not be relieved of my payment obligations below, will not receive a refund and Provider may retain any prepaid fees as agreed upon liquidated damages. Furthermore, the Program requires active participation of Child in accordance with the Program’s curriculum; PROVIDER DOES NOT WARRANT ANY SPECIFIED OUTCOME WITH RESPECT TO PARTICIPATION IN THE PROGRAM BY CHILD. PROGRAM IS NOT CONSIDERED A CHILD CARE FACILITY, A DAY CARE FACILITY, OR A CERTIFIED AFTER-SCHOOL PROGRAM. AS SUCH, THIS FACILITY IS NOT SUBJECT TO AND PROVIDER IS NOT REQUIRED TO COMPLY WITH STATE LICENSING STANDARDS, MONITORING REQUIREMENTS NOR STATE IMPOSED REGULATIONS. PARENT ACKNOWLEDGES THAT THE CURRICULUM USED DOES NOT, AND WILL NOT, QUALIFY PROVIDER TO SERVE AS A CHILD CARE FACILITY, DAY CARE FACILITY NOR AFTER-SCHOOL PROGRAM NOW OR IN THE FUTURE. IF PROGRAM IS DESIGNATED AS SUCH BY THE STATE BECAUSE OF A CHANGE OF LAW, PROVIDER AGREES TO NOTIFY PARENT AND APPLY FOR ANY PERMITTED EXCEPTIONS OR MODIFY THE PROGRAM ACCORDINGLY SO THAT IT IS NOT CLASSIFIED AS A CHILD CARE FACILITY, AFTER-SCHOOL PROGRAM, DAY CARE FACILITY OR ANYTHING SIMILAR, AND PARENT AGREES TO ANY ACTION THAT IS IN FURTHERANCE OF THIS EFFORT. III. Anti-bullying and Zero-Tolerance Policy. Parent/Child acknowledges that everyone has the right to feel physically and emotionally safe in the center. As members of the AoE Esports community, Parent/Child will do everything reasonably possible to create and preserve a safe, healthy, and positive learning environment. As defined in this section, bullying refers to verbal acts (Ex: name calling, joking or making offensive remarks about religion, gender, ethnicity, sexual orientation or socioeconomic status), physical acts (Ex: punching, tripping, sexual harassment or assault or any unwanted physical conduct), or other acts of harassment or intimidation either in person or through other means such as electronically (Ex: spreading rumors or posting degrading, harmful, or explicit pictures, messages, or information using social media, email, text or other forms of electronic communication or cyberbullying) (collectively “Bullying”) with the policy called the “anti-bullying rule”). I/Parent and my Child understand that Bullying will not be tolerated (whether it be cyberbullying, physical or verbal acts, or any activity that disrupts the learning environment), that Provider may take corrective action to prevent or stop any such activity, and that a violation of the anti-bullying rule is a basis for immediate dismissal from the Program. Child agrees to notify Provider immediately if he/she becomes aware of Bullying or other harmful activity that occurs during the Program. a) Parent agrees to discuss the ongoing experience of the Child with the Child and to promptly notify Provider of any concerns or incidents. b) Provider reserves the right to amend this policy by modifying the rules of conduct maintained at Provider’s facility. Please check these periodically for updates and revisions to the anti-bullying policy. IV. Photo Permission. I/Parent hereby grant Provider permission to use my Child’s likeness in a photograph, video, or other digital media (“photo”) in any and all its publications, including web-based publications, without payment or other consideration. I hereby acknowledge and affirmatively authorize the Provider to use photo images of my Child. V. Emergency Medical Treatment. In the event of a medical emergency, the Program staff will first use reasonable efforts to contact the parent(s) and /or guardian(s) before administering or authorizing any treatment. However, I/Parent understand(s) that the Provider does not have medical personnel/devices available and that staff is not authorized to provide medical treatment. If a medical emergency arises during the Program, I/Parent agree(s) and hereby grant Provider permission to authorize any medical care or emergency medical treatment by any third party that it deems qualified to provide such treatment. I/Parent understand(s) and agree that Provider assumes no responsibility nor liability (financial or otherwise) for any injury or damage which might arise out of, or in connection with, such authorized treatment. I/Parent further state(s) that there are no undisclosed health-related conditions, health issues or medical diagnosis that Provider should be aware of that would preclude or restrict my Child from use of the Transportation, if offered, or fully participating in the Program. I/Parent acknowledge that my Child has adequate health insurance to provide for and pay any medical costs that may be attendant because of injury or harm to Child. Parent agrees during the period of participation of Child in the Program to maintain in full force and effect adequate medical insurance and to indemnify and hold Provider harmless from all claims and costs arising out of any medical emergency. It is agreed that Parent will maintain updated and current contact telephone and email information during the term of the Child’s participation in the Program and that the term “medical emergency” means and refers to events which would prompt a reasonable person to seek medical care. I/Parent further acknowledge that it is my sole responsibility to notify, inform, and update Provider of any medical conditions of Child, including but not limited to known drug and food allergies, known dietary restrictions, and other medical conditions. Provider is not trained or licensed to and does not intend to administer medication or other life-saving treatment and thus if Child has any condition that the Parent determines is such that emergency treatment might be required during the Program, I/Parent agree to remain present at the facility to ensure Child’s safety and well-being. VI. Acknowledgment, Acceptance, and Assumption of Risks. I/Parent understand that supervision will be provided to the best of our ability, but I also recognize that situations and problems can arise, and that the Provider shall not be held responsible for circumstances either between my Child and any other participant. Parent and Child shall promptly notify the Provider of all situations and problems as, when and if they arise. This document provides and imparts enough warning that dangerous conditions, risks and hazards are inherent in utilizing the Transportation, if provided, or generally related to Child’s participation in the Program, and in any independent activities undertaken in conjunction with the Program. I understand that my Child’s presence and participation in the Program and/or Transportation, if provided, may expose him/her to such dangerous conditions, risks and hazards, which include, but are not limited to, automobile accidents, theft or destruction of personal property, exposure to unrestricted information via electronic devices, personal injury of Child or myself at the Facility or during Transportation, including those injuries caused by another child, and all other foreseeable or unforeseen injuries to Child or myself arising out of the Program and/or the Transportation. I/Parent acknowledge that the description of risks above is not complete and other unknown or unanticipated risks may result in property loss, injury or other harm. On behalf of myself and my Child, I/Parent, the undersigned, voluntarily sign this Waiver and Assumption of Risk on behalf of myself and my Child in favor of Provider, in consideration for the opportunity to have my Child participate in the Program(s) offered by Provider and/or utilize the Transportation, if provided, and engage in other activities sponsored by Provider, including but not limited to: interactions with staff and other participants, interaction with computer technology and the internet, consumption of food, and any indoor or outdoor activities related to the curriculum or Program(s). I hereby attest and verify I have been sufficiently advised of the potential risks, and I have full knowledge of the risks of my Child’s involvement in these activities and assume any risks including, but not limited to, expenses incurred in the event of an accident, illness, or other incapacity, regardless of whether I have specifically authorized such expenses, risk, etc. Knowing the dangers, hazards, and risks of such activities and in consideration of being permitted to utilize the Transportation, if provided, and/or my Child’s participation in the Program, I also agree to assume all risks inherent of my Child’s noncompliance with the Provider’s rules of conduct, Transportation Rules, and/or conduct in violation of the laws of the State of Michigan, as well as any code of conduct applicable to the Program participants in general. I acknowledge and voluntarily assume the risks of illness, injury, or other harm associated with these activities, inherent or otherwise, and whether they are described above. I further acknowledge that as the Parent, I have discussed the activities and risks with him or her, the minor child understands them and wishes to participate nevertheless, and I consent to such participation, by my signature below. I/Parent have advised my child that he/she is not authorized to leave the facility without adult supervision, or with an unauthorized person and that if he/she voluntarily leaves without permission or authority then Provider is not responsible, and that this may serve as a basis for immediate dismissal from the Program. VII. Representations Before Signing Agreement. I/Parent acknowledges that this Agreement shall be governed by and construed in accordance with the laws of the State of Michigan without regard to its conflicts of law provisions. The parties further agree that all disputes shall be resolved exclusively in state court in Michigan. If any term or provision of this Release shall be held illegal, unenforceable, or in conflict with any governing law, it shall be severed and the validity of the remaining portions shall not be affected thereby provided that the fundamental terms and conditions of this Agreement (including, without limitation, Sections I, II, VI, and VIII) remain legal and enforceable, the remainder of this Agreement shall remain operative and binding on the Parties. All provisions of this Agreement are binding upon me, my heirs, successors and assigns and the estate. BY SIGNING THIS AGREEMENT, I REPRESENT AND SPECIFICALLY WARRANT THE FOLLOWING: (a) I am the parent or legal guardian of Child, and have full authority to execute this Agreement; (b) I have had ample opportunity to read this Agreement and have so done; (c) I fully understand and voluntarily agree to each term of the Agreement; (d) I am under no duress or requirement to sign this Agreement; (e) I have not been induced to sign this Agreement by the statement or conduct of Provider; (g) I have the personal mental competency and legal capacity to understand and enter into this Agreement on behalf of myself and Child; and (h) I am over the age of 18. VIII. Release of Liability. THIS IS A RELEASE OF LEGAL RIGHTS. PLEASE READ AND BE CERTAIN YOU UNDERSTAND BEFORE SIGNING. BY SIGNING THIS AGREEMENT I/PARENT DO HEREBY IN ADVANCE (FOR MYSELF AND TO THE MAXIMUM EXTENT ALLOWED BY LAW, ON BEHALF OF THE MINOR) WAIVE, VOLUNTARILY RELEASE, ACQUIT, FOREVER DISCHARGE, AND COVENANT NOT TO SUE PROVIDER, ITS OWNERS, MEMBERS, OFFICERS, SHAREHOLDERS, DIRECTORS, AGENTS, EMPLOYEES, INSTRUCTORS, DRIVERS, AUTHORIZED REPRESENTATIVES AND ALL PERSONS AND ENTITIES OF, AND AGREE TO INDEMNIFY AND HOLD HARMLESS THE PARTIES ABOVE FROM ANY/ALL ACTIONS, CAUSES OF ACTION, CLAIMS, DEMANDS, DAMAGES, COSTS, LOSS OF SERVICES, EXPENSES, AND COMPENSATION, ON ACCOUNT OF OR IN ANY WAY GROWING OUT OF OR GENERALLY CONNECTED WITH, ANY AND ALL KNOWN OR UNKNOWN PERSONAL INJURIES (PHYSICAL OR MENTAL), PERSONAL PROPERTY DAMAGE, OR DEATH RESULTING FROM MY AND MY CHILD’S ATTENDANCE, ENROLLMENT OR PARTICIPATION IN THE PROGRAM OR ANY ACTIVITIES SPONSORED BY AOE ESPORTS, LLC., TRANSPORTATION TO THE FACILITY AND INCLUDING SUCH CLAIMS CAUSED IN WHOLE OR IN PART (OR ALLEGED) BY THE NEGLIGENCE, ACTS OR OMISSIONS OF ANY RELEASED PARTY. SHOULD I OR MY SUCCESSORS ASSERT ANY CLAIM IN CONTRAVENTION TO THIS AGREEMENT, I AND MY SUCCESSORS SHALL BE LIABLE FOR THE EXPENSES INCLUDING LEGAL FEES INCURRED BY THE OTHER PARTY OR PARTIES IN DEFENDING UNLESS THE PARTY OR PARTIES ARE ADJUDICATED FINALLY LIABLE ON SUCH CLAIM FOR GROSS OR WILLFUL AND WANTON NEGLIGENCE. THIS RELEASE EXTENDS TO AND INCLUDES, BUT IS NOT LIMITED TO, ALL DAMAGES OF EVERY KIND, COMPENSATORY, STATUTORY, CONTRACTUAL, AND UNDER WARRANTY, ALLEGEDLY OCCURRING BOTH IN THE PAST AND WHICH ALLEGEDLY MAY OCCUR IN THE FUTURE, WHICH COULD BE ASSERTED BY ME (PARENT), CHILD, OR BY OTHERS CLAIMING DAMAGES FROM ANY INJURIES I OR MY CHILD MAY SUSTAIN AS A RESULT OF MY EXECUTION OF THIS AGREEMENT OR CHILD’S PARTICIPATION IN THE PROGRAM OR TRANSPORTATION; THESE INCLUDING ALL PREJUDGMENT AND POST-JUDGMENT INTEREST; AND ANY AND ALL OTHER ALLEGED DAMAGES, ALL LOSSES AND EXPENSES OF EVERY KIND, WHETHER KNOWN OR UNKNOWN, AND WHICH ARE OR MAY BE ATTRIBUTABLE TO PROVIDER OR PROVIDER’S EMPLOYEES, OFFICERS, OR AGENTS, ALL OF WHICH ARE RELEASED HEREIN. I FURTHER AGREE TO INDEMNIFY THE RELEASED PARTIES AND EACH OF THEM FROM ANY AND ALL CLAIMS BROUGHT BY A THIRD PARTY, INCLUDING A CO-PARTICIPANT, FOR ANY INJURY OR LOSS SUFFERED BY THAT PERSON CAUSED IN WHOLE OR PART BY MY CHILD’S CONDUCT OR FAILURE TO ACT. IX. Miscellaneous. This Agreement contains the entire agreement between the parties and may only be amended in writing with the parties’ mutual consent. Neither this Agreement nor any of the rights, interests or obligations hereunder shall be assigned by any party without the prior written consent of the other party. CommentsThis field is for validation purposes and should be left unchanged.