Teen & Tweens YOGA Liability Waiver

Please read ALL of the following information. A legal guardian or parent must provide a legal

signature.

IN CONSIDERATION OF the risk of injury that exists while participating in Tweens &

Teens FREE YOGA at the Somerville Public Library ; and

IN CONSIDERATION OF my desire to participate in said Activity and being given the

right to participate in same;

I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal

representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also

volunteers, heirs, representatives, predecessors, successors and assigns (collectively

"Releasees"), from any physical or psychological injury that I may suffer as a direct

result of my participation in the aforementioned Activity.

X (parent initial required) ___________

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I

AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE

OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY

INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY,

PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT

DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND

I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any

and all claims, suits or actions of any kind whatsoever for liability, damages,

compensation or otherwise brought by me or anyone on my behalf, including attorney's

fees and any related costs.

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions,

acts or failures to act of any party or entity conducting a specific event or activity on

behalf of Releasees. In the event that I should require medical care or treatment, I

authorize MOTA LLC to provide all emergency medical care deemed necessary,

including but not limited to, first aid, CPR, the use o f AEDs, emergency medical

transport, and sharing of medical information with medical personnel. I further agree to

and mental limits and may carry with it the potential for death, serious injury, and

property loss. I agree not to participate in the Activity unless I am medically able and

properly trained, and I agree to abide by the decision of the MOTA LLC official or agent,

regarding my approval to participate in the Activity.

X (parent initial required) ___________

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND

RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I

EXPRESSLY AGREE TO RELEASE AND DISCHARGE MOTA AND ALL OF ITS

AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF,

VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS

this release is also for such negligence on the part of MOTA LLC, its agents, and

employees.

I agree that this Release shall be governed for all purposes by Massachusetts law,

without regard to any conflict of law principles. This Release supersedes any and all

previous oral or written promises or other agreements.

In the event that any damage to equipment or facilities occurs as a result of my or my

family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree

to be held liable for any and all costs associated with any such actions of neglect or

recklessness.

X (parent initial required) ___________

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE

Parent/Legal Guardian’s Name:

EMERGENCY CONTACT #1:

NAME: _______________________________

RELATIONSHIP _______________________________

BEST CONTACT NUMBER ___________________________________

EMERGENCY CONTACT #2:

NAME: ___________________________________________________

RELATIONSHIP ___________________________________________

BEST CONTACT NUMBER ___________________________________

PARENT SIGNATURE ___________________________________________

DATE: ________________________________________________________