RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
NOTICE OF EXEMPTION
In consideration of participation in the Summer STEM Camp activity organized by MathMind
Workshop, P.O. Box 222, Bogart, Georgia, 30622 and/or use of the property, facilities and
services of MathMind Workshop, I agree for myself and for the Minor Participant of my family
to the following:
1. AGREEMENT TO FOLLOW DIRECTIONS. I agree to observe and obey all posted rules and
warnings, and further agree to follow any oral instructions or directions given by MathMind
Workshop, or the owners, employees, representatives, volunteers or agents (hereinafter
collectively referred to as "Protected Parties”) of MathMind Workshop.
2. ASSUMPTION OF THE RISKS: I recognize that there are certain inherent risks associated
with the above described activity that cannot be avoided or eliminated and I assume full
responsibility for personal injury to myself and the Minor Participant.
I acknowledge that Summer STEM Camp is not a licensed childcare facility and is not insured.
I also acknowledge that this program is not required to be licensed by the Georgia
Department of Early Care and Learning and this program is exempt from state licensure
3. RELEASE AND WAIVER OF LIABILITY: I, for myself and on behalf of my family members,
release and agree not to sue Protected Parties for injury, loss or damage, arising out of my or the
Minor Participant’s use of or presence upon the facilities of MathMind Workshop, whether
caused by the fault of myself, Minor Participant, Protected Parties or other third parties.
I understand that this release of liability will prevent me and my family members from
bringing any lawsuit or making any claim for personal injury, damages or death connected with
participating in the activities or using the MathMind workshop facilities.
4. INDEMNIFICATION. I agree to hold harmless, indemnify and defend Protected Parties
against all claims, causes of action, damages, judgments, costs or expenses, including attorney
fees and other litigation costs, which may in any way arise from my or the Minor Participant’s
use of or presence upon the facilities of MathMind Workshop. Such indemnity obligation shall
include, but not be limited to, any claim, action or proceeding that alleges that I or the minor
participant negligently or intentionally caused any injury, death or damage to other participants
in the activities or other third parties.
RELEASE OF LIABILITY
5. FEES. I agree to pay for all damages to the facilities of MathMind Workshop caused by any
negligent, reckless, or willful actions by me or my family.
6. MEDICAL AUTHORIZATION. In the event of an injury to the listed Minor Participant
during the above described activities, I give my permission to MathMind Workshop or to the
employees, representatives or agents of MathMind Workshop to arrange for all necessary
medical treatment for which I shall be financially responsible.
I understand that MathMind workshop does not have a nurse on staff and cannot dispense
regularly taken medication to participants.
7. TERM OF AGREEMENT. I understand that this agreement shall continue in effect and will
be in full force and legal effect for the duration of the activity for which the Minor Participant is
registered. I agree that MathMind Workshop may require me to sign a new agreement at any
time as a requirement for my participation or the participation of the minors in the activities.
8. APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the
above shall be resolved under Georgia law.
9. NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign this
Agreement and that I have been given a reasonable opportunity to review it before signing. I
further agree and acknowledge that I am free to have my own legal counsel review this
Agreement if I so desire.
10. ARM'S LENGTH AGREEMENT. This Agreement and each of its terms is the product of an
arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the
interpretation of this Agreement, or any of its provisions, the Parties, and each of them,
explicitly reject the application of any legal or equitable rule of interpretation which would lead
to a construction either "for" or "against" a particular party based upon their status as the drafter
of a specific term, language, or provision giving rise to such ambiguity.
11. ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement,
whether standing alone or as applied to a particular occurrence or circumstance, shall not affect
the validity or enforceability of any other provision of this Agreement or of any other
applications of such provision, as the case may be, and such invalid or unenforceable provision
shall be deemed not to be a part of this Agreement.
12. DISPUTE RESOLUTION. The parties will attempt to resolve any dispute arising out of or
relating to this Agreement through friendly negotiations amongst the parties. If the matter is
not resolved by negotiation, the parties will resolve the dispute using the below Alternative
Dispute Resolution (ADR) procedure.
Any controversies or disputes arising out of or relating to this Agreement will be submitted to
mediation in accordance with any statutory rules of mediation. If mediation is not successful in
resolving the entire dispute or is unavailable, any outstanding issues will be submitted to final
and binding arbitration under the rules of the American Arbitration Association. The
arbitrator's award will be final, and judgment may be entered upon it by any court having
I understand that by signing this agreement, I am giving up rights that I may have to bring a
legal action or assert a claim against the Protected Parties on the basis of their negligent acts
or omissions. I understand that by signing this agreement I may be found by a court of law to
have forever waived my rights and the rights of the Minor Participant to maintain any action
against the Protected Parties on the basis of any claim from which I have released the
I also give permission for photographs and video and/or audio recordings of the Minor
Participant to be used in promotional materials by MathMind Workshop.
If this page does not redirect you to the home page after pressing submit, scroll back up through the form to check for any information that was entered incorrectly.
You must be 18 or over to fill out this waiver.