Please read the following information:
IN CONSIDERATION of being allowed to participate in the Activity and other good and valuable consideration, the receipt which is hereby acknowledged, I, the parent of the above-named camper (the “Participant”) agree with Tokyo Coding Club (“Activity Provider”) to the following:
DETAILS OF ACTIVITY
The participant will be participating in the following activities:
- Overnight camp (see schedule for details)
- STEM Lessons hosted by Tokyo Coding Club
- Outdoor activities local to the area (see schedule for details)
Being the Participant’s Parent or Guardian, I hereby acknowledge and agree to the following:
I am the parent or legal guardian of the Participant. I make an oath that there are no court orders now in effect that would prohibit me from conferring the power to consent upon another person.
I understand and acknowledge that the Tokyo Coding Club shall, to the best of its ability, (i) ensure the safety and well-being of the Participant; (ii) its personnel are adequately prepared and trained to provide the basic needs and assistance to the participant, as may be necessary; and, (iii) provide appropriate instructions and guidelines to the participant. However, I also recognize, understand, and acknowledge that: (i) The Activity has foreseeable and unforeseeable inherent risks, hazards, and dangers that no amount of care, caution or expertise can eliminate, including without limitation, the potential for serious bodily injury, permanent disability, paralysis, and loss of life; (ii) the Tokyo Coding Club has a difficult task to ensure safety and it is not infallible. It may be unaware of the Participant’s fitness or abilities, may give incomplete warnings or instructions, or may misjudge weather or environmental conditions, and the equipment to be used for the activities might malfunction.
I am voluntarily allowing the Participant to participate in the activities. In consideration of that participation, I hereby acknowledge that I am aware of the risks, dangers and hazards thereof and that the Participant may be exposed to such risks, dangers, and hazards. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, that the Participant may sustain as a result of participating in the Activity, unless caused by the gross negligence or willful misconduct of Tokyo Coding Club.
I hereby undertake and represent that the Participant will comply with the rules and regulations for participating in the Activity and to comply with the rules of the facility where the Activity will be held.
I hereby undertake and represent that the Participant is mentally and physically fit and appropriate to participate in the Activity. Hence, the Participant does not have any physical limitations, medical ailments, or physical or mental disabilities that would limit or prevent the Participant from participating. If required, the Participant will obtain a medical examination and clearance.
I agree to secure and maintain a separate comprehensive insurance to cover any medical expenses for accidents and illnesses while the Participant is participating in the Activity and to cover any liability for loss, indemnity, or damage sustained or caused by the Participant during the period of the activities. I will submit a copy of the comprehensive insurance policy to Tokyo Coding Club at least five (5) days before the start date of the Activity.
I hereby grant Tokyo Coding Club permission to authorize any emergency medical treatment to the Participant as it deems appropriate and agree that such action by Tokyo Coding Club shall be subject to the terms herein. I understand and agree that Tokyo Coding Club assumes no responsibility for any injury or damage that might arise out of or in connection with such authorized emergency medical treatment. I give Tokyo Coding Club access to any and all records, including, but not limited to, insurance records regarding any medical services or treatment provided.
I agree that the Participant and I will not sue Tokyo Coding Club, its employees, administrators, legal representatives, and assigns and I release and forever discharge releases and forever discharges them from any and all liabilities, claims, demands, actions, causes of actions, costs and expenses of any nature whatsoever arising out of any loss, damage, or injury, including death, that may be sustained by the Participant or to any property belonging to the Participant, arising from the Activity or while upon the premises where the Activity is being conducted, excepting those claims arising from the gross negligence or willful misconduct of Tokyo Coding Club.
I and the Participant agree to indemnify and hold harmless Tokyo Coding Club, its administrators, legal representatives, and assigns from and against any loss, liability, damage or costs, including court costs and attorneys’ fees, that they may incur arising from the Participant’s involvement in the Activity, excepting those claims arising from the gross negligence or willful misconduct of Tokyo Coding Club.
I acknowledge that I have read this form, understand it, and agree to be bound by its terms otherwise I will not allow the Participant to join in the Activity. I further acknowledge that I give my consent voluntarily, freely and knowingly in order to provide for the Participant and not as a result of coercion, duress or payments by any person or agency. Hence, I acknowledge and agree with Tokyo Coding Club that: (1) we have given sufficient time to carefully read the contents herein; (2) we have been given the opportunity and has been encouraged to seek independent legal advice prior to signing and agreeing to the terms and conditions herein; (3) we fully understand the risks and claims that the Participant is waiving to participate in the Activity.
I acknowledge that this Waiver is given with the express intention of affecting the extinguishment of certain obligations owed to the Participant by Tokyo Coding Club, and with the intention of binding my and the Participant’s members of the family, estate, heirs, administrators, legal representatives, assigns and assets.
This Waiver will be governed by and construed in accordance with the laws of Japan.