As the parent/guardian of the above-named child (“My Child”), I agree that My Child may be eligible to participate in one or more of The Fresh Air Fund’s (“The Fund”) Summer 2020 programs and associated activities (“Fresh Air Activities”) located in either New York, NY, Fishkill, NY, Harriman State Park (NY) or via the online platform, as more fully described in The Fund’s promotional materials. I understand that The Fund is not responsible for any transportation to or from programming, unless The Fund agrees to provide transportation in writing signed by an agent of The Fund.
I understand that I may receive as much information from The Fund with respect to The Fresh Air Activities as I deem desirable and will have the opportunity to discuss the Fresh Air Activities with members of The Fund’s staff and/or volunteers prior to My Child’s participation. I understand that I am responsible for making my own independent assessment of the risks to My Child of participation in Fresh Air Activities, including the risks associated with participating in outdoor activities in New York City in July and August when the weather can reach very high temperatures.
I also understand that there are risks inherent in being around other people during the global novel coronavirus pandemic and I knowingly accept those risks. I understand that it is my responsibility to take precautions to keep myself and my Child safe by being aware of and complying with all health guidance from local, state and federal officials, as well as being aware of, reviewing with My Child, and complying with all The Fund rules and policies.
I understand that, although Fund Agents (as defined below) will monitor Fresh Air Activities within the scope of the individual programs as they are further defined, My Child may be unsupervised at times during participation. I agree that The Fund is not an insurer of the health or safety of My Child. I also agree that The Fund does not assume responsibility for spontaneous and unforeseen events that may occur during My Child’s participation in Fresh Air Activities.
I am aware that The Fresh Air Fund conducts short surveys with youth participants to get feedback on things like what they liked or disliked and to understand if the program helped their personal development. My child’s participation in these activities is voluntary. We do not anticipate that participation will result in distress on the part of your child. If you would like further information about our program evaluation work or if you do not want your child to participate in these activities, please contact The Fresh Air Fund at (212) 897-8900
or email us at: email@example.com prior to your child’s program start date.
In consideration of The Fund permitting My Child to participate in Fresh Air Activities: I, on behalf of My Child, myself, my spouse, my domestic partner and all other family members and the heirs, agents, executors, administrators, representatives and assigns of each of the foregoing and all persons claiming under them (collectively, the “Child Parties”), assume all risks involved in Fresh Air Activities. I agree that neither The Fund nor any of its former, current and future directors, officers, employees, volunteers, affiliates and agents (each of the foregoing, a “Fund Agent”) (including each Fund Agent who participates in the planning, organization or implementation of The Fresh Air Fund Activities) shall have any responsibility for any injury to person or property, illness, loss of life or property, liability, damage, expense or other adverse event that may occur during Fresh Air Activities, other than as the direct consequence of any gross negligence or willful misconduct of The Fund or any Fund Agent I further understand that this release shall be construed and governed under the law of the State of New York.
I understand that, as a result of my executing this release and in consideration of The Fresh Air Fund’s consent to my request to be present and participate in the Fresh Air Activities, I and the other Child Parties shall be forever barred from suing or otherwise asserting a claim, demand or cause of action against The Fund and The Fund Agents to the extent provided above.
I further agree that any unresolved dispute arising out of or relating to this agreement, my presence and participation in the Fresh Air Activities or otherwise arising between the parties shall will be resolved exclusively through mediation or arbitration, the choice being at the exclusive discretion of The Fund, and in accordance with the Commercial Rules of the American Arbitration Association. Any judgment upon the award rendered by the arbitrator(s) may be entered in any court of competent jurisdiction. Should any part of this agreement be found invalid or not enforceable, then the remaining portion shall continue to be valid and in force.
I hereby represent and warrant to The Fund that I am authorized to sign this Consent & Release Form on behalf of Child Parties and to bind them hereby. My signature/electronic signature affirms that:
I give The Fresh Air Fund permission to:
1. Use photos, image, likeness and/or videos of My Child and his/her/their first name in public relations efforts, including, but not limited to print and electronic media and ads, marketing brochures, and social media platforms. This permission extends to The Fresh Air Fund’s cooperating organizations.
Should my child require medical treatment during his/her participation, The Fresh Air Fund and its Agents have the following permissions:
2. Full authority to take the actions deemed necessary to ensure My Child’s physical and mental health and safety, including: securing and/or administering emergency first aid, CPR, and using an AED when deemed necessary; delivering routine and ensuring emergency health care; dispensing/administering medications; and seeking medical, dental, or vision treatment for my child, if necessary, while he/she/they are participating in the program.
3. To release any medical or other records necessary for treatment, referral, billing, or insurance purposes by The Fresh Air Fund to other medical personnel treating My Child.
4. To obtain medical care and treatment as may be deemed necessary for the health and safety of my child by duly licensed physicians, nurses, or qualified medical personnel of any hospital, urgent care facility, or clinic.
I acknowledge that:
5. I am responsible for My Child’s transportation to and from his/her/their program, and that he/she/they will only be released to the individuals listed under the Caregiver Information, Emergency Contacts, or Pick Up Authorizations sections of this application.
6. I acknowledge that only those participants aged 11 and older who have a Self-Dismissal Form signed by the caregiver on file may sign themselves out at the end of in-person programming.
7. My Child may use non-aerosol sunscreen and bug repellant he/she/they bring to the program or that the program has supplied, which is approved by the FDA for over-the-counter use to avoid overexposure to the sun. Sunscreen may be applied by program staff if My Child requests.
8. In addition to calls from The Fresh Air Fund’s staff and volunteers, information for application completion, participation confirmation, and other updates may be sent by email, text, or automated phone calls.
9. My Child must comply with all program rules and standards including, but not limited to virtual camp, play space, and internship rules, and cell phone, electronics, and technology rules. His/her/their failure to follow all rules may result in an early end to his/her summer experience. I acknowledge that The Fresh Air Fund has authority to end me or My Child’s participation at any time and for any reason, including for failure to follow shared, stated, and posted rules or exercise reasonable control over My Child.
10. My Child’s health insurance will be the primary coverage for any medical treatment he/she/they receives while participating in The Fresh Air Fund program, and that I may be responsible for fees for hospital, nursing, medical and surgical services that exceed the amounts covered by My Child’s health insurance.
11. I acknowledge my duty to provide truthful, accurate and timely information about My Child’s health and the health of members of my household, and I further acknowledge that, it may be necessary for my child to end their participation in his/her/their summer experience if he/she/they or members of the household are exhibiting signs or symptoms of the novel coronavirus or other infectious diseases.