Cultivating Change Summit Waivers


Cultivating Change Summit Activity Participation
Acknowledgment and Waiver

 

I acknowledge that as a part of my participation in the 2017 Cultivating Change Summit with the Cultivating Change Foundation, there is time scheduled during which there are opportunities for me to participate in voluntary recreational activities.

I understand that there are health risks associated with my participation with the Cultivating Change Summit including but not limited to the risk of injury, disability, or death, the worsening of any pre-existing medical condition, dizziness, nausea, muscle cramping, sprains, and strains or other personal injuries, heart attack, or stroke. If I have any health conditions which may prevent me from participating at the Cultivating Change Summit, I will refrain from participating or seek my doctor’s approval before participating. I understand that my participation in the Cultivating Change Summit is my personal decision and that the Cultivating Change Foundation is not responsible for any risks, injuries, or damages arising from my participation. I agree that I am responsible for abiding by all instructions, rules and regulations provided by the third party organizer of the Cultivating Change Summit.

I agree to assume the above risk of participation and all other risks and liabilities in relations to my participation with the Cultivating Change Summit. I agree to hold the Cultivating Change Foundation, its officers, directors, employees, agents, contractors and vendors and their parents, affiliates, subsidiaries, successors and assigns, harmless from any and all claims, demands, suits, losses, damages or related rights of action or causes of action, present or future, for any and all liability or responsibility for any such risks highlighted above. I acknowledge that to the greatest extent permissible by law, the Cultivating Change Foundation, its officers, directors, employees, agents, contractors and vendors and their parents, affiliates, subsidiaries, successors and assigns, will not be liable for any indirect damages or consequential loss arising out of or in connection with my participation in the Cultivating Change Summit. 

I acknowledge and confirm that this waiver and release shall be binding upon my heirs, spouse, or other next of kin, executors, administrators, and assigns and that I have read this waiver and release and understand all terms. I submit it voluntarily and with full knowledge of it significance.

By submitting my information below, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby.  I hereby release any and all claims against the Cultivating Change Foundation utilizing this material for the purposes described above.


Photograph and Video Release

I hereby grant the Cultivating Change Foundation and their vendor Studio 5 - Learning and Development, LLC permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape for purposes related to the Cultivating Change Summit without payment or any other consideration.  I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears.  Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.  I also understand that, absent my consent, this material may be used only for purposes related to the Cultivating Change Summit and Cultivating Change Foundation.

Photographic, audio or video recordings may be used for the following purposes (as limited by the preceding paragraph):

  • conference presentations
  • educational presentations or courses
  • informational presentations
  • social media/marketing
  • educational videos

By checking the box below I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in a public setting.

I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

By submitting this information below I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby.  I hereby release any and all claims against Cultivating Change Foundation and their vendor Studio 5 - Learning and Development, LLC utilizing this material for the purposes described above.

Summit Participation Waiver *
Photograph & Video Release *
Name *
Name
Birthday *
Birthday
Address *
Address
Phone *
Phone
Date *
Date
Signature *
Signature