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Release and Waiver of Liability - Assumption of Risk - Indemnity Agreement

Please fill out the following waiver

Release and Waiver of Liability - Assumption of Risk - Indemnity 

Agreement 

By completing this form, you are indicating that you have chosen to voluntarily let your child named herein to participate in indoor/outdoor individual and group occupational therapy activities and services offered through Dragonfly & Owl A Place to Soar, LLC. Activities vary and may include, among others, walking, running, rolling, swinging, climbing, crawling, and jumping. You further understand and acknowledge that the activities in indoor/outdoor individual and group occupational therapy have risks, including certain risks which are inherent. Inherent risks are those which cannot be eliminated without destroying the unique character of these activities. You understand that all types of bodily injury are a risk to participating in these activities. You understand that Dragonfly & Owl A Place to Soar, LLC, or any therapist, caregiver under their charge assumes no responsibility or liability for your child's participation in this indoor/outdoor individual and group occupational therapy activities and services, and you agree to assume all the risks of participating. 

 As a parent and/or legal guardian understand and voluntarily agree to release, waive, and agree not to sue Dragonfly & Owl A Place to Soar, LLC, or any therapist under their charge, for any and all claims, damages, costs, attorney's fees, or causes of action which I have or may in the future, as a result of damages or injuries relating to the participation or travel to and from the outdoor activity and inside Dragonfly & Owl A Place to Soar, LLC,  building, arising out of or incident to any negligent act or omission by Dragonfly & Owl A Place to Soar, LLC.  

I knowingly give up valuable legal rights, including the right to sue. As a parent and/or legal guardian understand and agree that there exist risks of harm associated with participating in indoor/outdoor individual and group occupational therapy activities and services offered through Dragonfly & Owl A Place to Soar, LLC, which may give rise to bodily injury. These risks include, but are not limited to hazards associated with strenuous activity, exposure and emergencies related to heat, personal injury including physical trauma, exhaustion, broken bones, dislocations, bruises, cuts, and any other injuries that may result in physical contact with others. I further understand and agree that there may be risks and dangers not known or reasonable foreseeable at this time. I understand and agree that included within the scope of this waiver and release is any cause of action, arising from the failure to warn of existing dangerous conditions not known to or reasonable discovered by Dragonfly & Owl A Place to Soar, LLC,, or any Intern under their charge. 

 I knowingly and voluntarily assume full responsibility for these risks arising out of or related to my child named herein participation in indoor/outdoor individual and group occupational therapy activities and services offered through Dragonfly & Owl A Place to Soar, LLC.  

I HAVE CAREFULLY READ, AND I UNDERSTAND, ACKNOWLEDGE AND AGREE TO THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT. I UNDERSTAND THAT I AM GIVING UP VALUABLE LEGAL RIGHTS BY SIGNING THIS AGREEMENT, AND THAT THIS AGREEMENT REPRESENTS A CONTRACT BETWEEN DRAGONFLY & OWL A PLACE TO SOAR, LLC AND MYSELF. I HAVE VOLUNTARILY CHOSEN THE ACTIVITIES IN WHICH MY CHILD IS PARTICIPATING.  

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