JASEN AUTISM SENSORY ENVIRONMENT, LLC,
PARTICIPANT AGREEMENT, INDEMNIFICATION, GENERAL RELEASE AND ASSUMPTION
(PLEASE READ THIS DOCUMENT CAREFULLY, BY SIGNING IT, YOU ARE WAIVING YOUR AND/OR YOUR SPOUSE AND MINOR’S LEGAL RIGHTS)
BY SIGNING THIS AGREEMENT I AM GIVING UP MY RIGHTS AND THE RIGHTS OF MY SPOUSE AND/OR CHILD(REN) TO SUE JASEN AUTISM SENSORY ENVIRONMENT, LLC, OR ITS EMPLOYEES, MANAGERS, DIRECTORS OR AGENTS, FOR ANY INJURY, INCLUDING PARALYSIS OR DEATH,
CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OR FAULT OF JASEN AUTISM SENSORY ENVIRONMENT, LLC INCLUDING ANY OF ITS AGENTS, EMPLOYEES AND EQUIPMENT. Initials:
In consideration of being allowed to participate in the services and activities, including, but not limited to, center access, center use, sensory room and any other activities (collectively “ACTIVITIES”), provided by Jasen Autism Sensory Environment, LLC and its agents, owners, officers, directors, principals, volunteers, participants, clients, customers, invitees, employees, independent contractors, insurers, facility operators, land and/or premises owners, and any and all other persons and entities acting in any capacity on its behalf (collectively “JASEN AUTISM SENSORY ENVIRONMENT”), at 12393 Hagen Ranch Rd, Boynton beach, FL, I, on behalf of myself, and/or on behalf of my spouse, minor child(ren)/ward(s), hereby agree to forever release, indemnify and discharge JASEN AUTISM SENSORY ENVIRONMENT on behalf of myself, my spouse, legal partner, my children, my parents, my guardians, heirs, assigns, personal representatives and estate, and all other persons and entities set forth below. The undersigned, for myself, and/or on behalf of my spouse, minor child(ren)/ward(s), hereby acknowledges, agrees and represents that immediately upon entering or participating I will, inspect and carefully consider JASEN AUTISM SENSORY ENVIRONMENT’S premises and facilities. It is further warranted that such entry into JASEN AUTISM SENSORY ENVIRONMENT’S facilities for observation or use of any facilities or equipment or participation in ACTIVITIES constitutes an acknowledgement that such premises and all facilities and equipment thereon have been inspected and carefully considered and that the undersigned finds and accepts same for myself, and/or on behalf of my spouse, minor child(ren)/ward(s) as being safe and reasonably suited for the purpose of such observation, use or participation by myself, and/or by my spouse, minor child(ren)/ward(s). The undersigned, for myself, and/or on behalf of my spouse, minor child(ren)/ward(s) hereby represent that (i) I/we are in good health and in proper physical condition to participate in the activities in which JASEN AUTISM SENSORY ENVIRONMENT provides; and (ii) I/we are not under the influence of alcohol or any illicit or prescription drugs which would in any way impair my/our ability to safely participate in activities; (iii) I/we have not been advised against activities by a heath professional. I agree that it is my sole responsibility to determine whether I/we are sufficiently fit and healthy enough to participate in activities. The undersigned for myself, and/or on behalf of my spouse, minor child(ren)/ward(s), accepts sole responsibility for my own conduct and actions, as well as the conduct and actions of my spouse, minor child(ren)/ward(s) while participating in the activities, and the condition and adequacy of the equipment.
(1) RELEASE OF LIABILITY:I understand and acknowledge that JASEN AUTISM SENSORY ENVIRONMENT and its owners, managers, employees, and agents who may be monitoring or chaperoning the center, are not therapists or conducting any therapy. Additionally, despite all known and unknown risks including but not limited to serious bodily injury, permanent disability, paralysis and loss of life, I, on behalf of myself, and/or on behalf of my spouse, minor child(ren)/ward(s) hereby expressly and voluntarily remise, release, acquit, satisfy and forever discharge and agree not to sue JASEN AUTISM SENSORY ENVIRONMENT, and its suppliers, designers, installers, manufacturers of any gym equipment, or such other material and equipment in JASEN AUTISM SENSORY ENVIRONMENT’S facility (all hereinafter referred to as “EQUIPMENT SUPPLIERS”) and agree to hold said parties harmless of and from any and all manner of actions or omission(s), causes of action, suits, sums of money, controversies, damages, judgments, executions, claims and demands whatsoever, in law or in equity, including, but not limited to, any and all claims which allege negligent acts and/or omissions committed by JASEN AUTISM SENSORY ENVIRONMENT or any EQUIPMENT SUPPLIERS, whether the action arises out of any damage, loss, personal injury, or death to me or my spouse, minor child(ren)/ward(s), while participating in or as a result of participating in any of the ACTIVITIES in or about the premises. This Release of Liability, is effective and valid regardless if whether the damage, loss or death is a result of any act or omission on the part of JASEN AUTISM SENSORY ENVIRONMENT and/or any EQUIPMENT SUPPLIERS.
(2) INDEMNIFICATION: I understand that the known and unknown risks may be caused in whole or in part by my or my spouse or child(ren)/ward(s) own actions or inactions of others participating in activities, or the acts, inaction or negligence of JASEN AUTISM SENSORY ENVIRONMENT or any EQUIPMENT SUPPLIERS, and in consideration of being allowed, along with my spouse and/or child(ren/ward(s) to participate in the ACTIVITIES, I hereby assume all risk of damage, loss, personal injury or death to myself, my spouse and/or my minor child(ren)/ward(s) to participate in the ACTIVITIES, I hereby assume all risk of damage, loss, personal injury, or death to myself, my spouse and/or my minor child(ren)/ward(s) as a result of the participation in ACTIVITIES in or about the facility, including any such loss due to any negligence of JASEN AUTISM SENSORY ENVIRONMENT and all EQUIPMENT SUPPLIERS and agree to indemnify and hold harmless JASEN AUTISM SENSORY ENVIRONMENT and all EQUIPMENT SUPPLIERS from and against any and all losses, liabilities, claims, obligations, costs, damages and/or expenses whatsoever paid, incurred and/or suffered by JASEN AUTISM SENSORY ENVIRONMENT and all EQUIPMENT SUPPLIERS as a result of any claims asserted by myself, my spouse and/or child(ren)/ward(s) against JASEN AUTISM SENSORY ENVIRONMENT and all EQUIPMENT SUPPLIERS, including, but not limited to, any and all attorney’s fees, costs, damages and/or judgments JASEN AUTISM SENSORY ENVIRONMENT and all EQUIPMENT SUPPLIERS incurs in the event of such loss whether caused by the negligence of JASEN AUTISM SENSORY ENVIRONMENT of any EQUIPMENT SUPPLIERS and that on behalf of myself, my spouse or my minor child(ren)/ward(s) I further agree to indemnify and hold harmless JASEN AUTISM SENSORY ENVIRONMENT for any injury, damage and/or harm myself, my spouse and/or my minor child(ren)/ward(s) cause to JASEN AUTISM SENSORY ENVIRONMENT or its facility and/or to any and all other persons and entities in any capacity on behalf of JASEN AUTISM SENSORY ENVIRONMENT.
(3) ATTORNEY’S FEES: I promise to indemnify JASEN AUTISM SENSORY ENVIRONMENT for any attorney’s fees and/or costs incurred by JASEN AUTISM SENSORY ENVIRONMENT to enforce this agreement, including all costs associated with any collection efforts. Further, should any debt and/or judgment accrue in favor of JASEN AUTISM SENSORY ENVIRONMENT, pre-judgment and post-judgment interest shall accrue thereon at a rate of 18% per annum.
(4) PHOTO RELEASE: By entering JASEN AUTISM SENSORY ENVIRONMENT and participating in the ACTIVITIES, I hereby grant JASEN AUTISM SENSORY ENVIRONMENT on behalf of myself, my spouse and on behalf of my child(ren)/ward(s), the irrevocable right and permission to photograph and/or record me, my spouse or my child(ren)/ward(s) in connection with JASEN AUTISM SENSORY ENVIRONMENT and to use the photograph and/or recording for all purposes, including advertising and promotional purposes, in any manner and all media now and hereafter known, in perpetuity throughout the world, without restriction as to alteration. I waive any right to inspect or approve the use of the photograph and/or recording, and acknowledge and agree that the rights granted to this release are without compensation of any kind.
(5) TERMS OF AGREEMENT: I understand that this agreement extends forever into the future and will have full force and legal effect each and every time I or my spouse and/or child(ren)/ward(s) visit JASEN AUTISM SENSORY ENVIRONMENT, whether at the current location or any other location or facility. The undersigned further expressly agrees that this agreement is intended to be as board and inclusive as is permitted by the laws of this state and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
(6) VENUE: In the event a lawsuit is filed against JASEN AUTISM SENSORY ENVIRONMENT, I agree to the sole and exclusive venue of Palm Beach County, Florida. I further agree that the substantive law of Florida shall apply without regard to any conflict of law rules.
JASEN AUTISM SENSORY ENVIRONMENT, LLC AGREEMENT
By signing this document, I understand that I may be found by a court of law to have forever waived my right and my spouse and/or child(ren)/ward(s) right to maintain any action against JASEN AUTISM SENSORY ENVIRONMENT on the basis of any claim from which I have released JASEN AUTISM SENSORY ENVIRONMENT and any released party herein and that I have assumed all risk of damage, loss, personal injury, or death to myself, my spouse, and/or my minor child(ren)/ward(s) and agreed to indemnify and hold harmless JASEN AUTISM SENSORY ENVIRONMENT and all EQUIPMENT SUPPLIERS from and against any and all losses, liabilities, claims, obligations, costs, damages, and/or expenses whatsoever paid, incurred and/or suffered by JASEN AUTISM SENSORY ENVIRONMENT and all EQUIPEMENT SUPPLIERS as a result of the participation in ACTIVITIES in or about the facility by myself, my spouse and/or child(ren)/ward(s) and/or claims asserted by myself, my spouse and/or child(ren)/ward(s) against JASEN AUTISM SENSORY ENVIRONMENT and all EQUIPMENT SUPPLIERS related to such participation in ACTIVITES. I have had a reasonable and sufficient opportunity to read and understand this entire document and consult with legal counsel, or have voluntarily waived my right to do so. I knowingly and voluntarily agree to be bound by all terms and conditions set forth herein.
You MUST be 18 years old or older to sign you own waiver and/or
You MUST be the Parent or Legal Guardian to sign for a minor (under age 18)
(If under age 18, it must be completed by Parent/Legal Guardian)
We reserve the right to review your license and/or other forms of ID to verify identity and age.