Kickball and PE Games Parent/Teacher Agreement

Please complete the form below
PLEASE READ CAREFULLY AS THIS REPRESENTS A CONTRACT BETWEEN YOU, THE PARENT, AND WES KOERNER 

    Informed Consent and Release
    PLEASE READ CAREFULLY AND SIGN BELOW TO INDICATE YOUR AGREEMENT 
    NOTE: THIS FORM INCLUDES A RELEASE OF LIABILITY

    I, the undersigned parent(s) or guardian(s), hereby give permission for my above named child to participate in the Kickball or Beginning Kickball class taught by Wes Koerner.  Kickball involves physical activity with other children in a park environment including running, kicking, catching, throwing, being hit by balls and possible accidental or incidental collisions with other children.  Furthermore, the activity takes place in a public park under the supervision of one adult coach, who is a certified public health and PE teacher.

    ​I certify that I am hiring Wes Koerner to supplement my child's education and I have taken the necessary steps to inform myself of the qualifications and experience of the teacher and have determined that the above said class is appropriate for my child.  I further certify that any issues that may arise with regard to the content of the class, my child's performance and/or his behavior shall be addressed to the teacher.
     
    I grant to PLANT, Inc. the right to take photographs of my student as a participant in this class and I agree that PLANT, Inc. may use such photographs of my student without a name for any lawful purpose including publicity, illustration, advertising and web content.
     
    I certify that my child is able to participate in any and all of these activities. I further certify that I will either remain at the park or I may be reached at the phone number listed on the registration sheet, in the event that an emergency occurs. I understand that I must check my child in and out of class with the teacher and am not to drop my child off unattended at the park nor have them remain unattended at the park after the conclusion of the class. 
     
    In the event that my child becomes injured or ill during class, I hereby authorize Wes Koerner or his representative to seek medical treatment, including but not limited to securing the services of a physician or hospital. I will assume responsibility for all medical expenses incurred.
    I understand that Wes Koerner strives to create a safe, positive experience for all the children. If my child becomes disruptive, or a danger to himself/herself or others, I understand that I may be called to come and pick him/her up.   If my child has not been picked up within 5 minutes following the conclusion of the class I realize that appropriate authorities will be contacted to take responsibility of my child.
     
    I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS THAT MAY BE ENCOUNTERED IN SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do, for myself and for my child, heirs, and assigns, to the fullest extent permitted by law, hereby irrevocably and unconditionally release, acquit, and forever discharge Wes Koerner, and  PLANT, Inc.  their agents, employees, and volunteers from any and all liability, actions, causes of actions, claims, expenses, obligations, and damages of any nature whatsoever, which I now have or which may arise in the future, in connection with my child's participation in the described activities or in any other associated activities including, but not limited to, any injury to my child or property, even injury resulting in death.
     
    I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the laws of the state of New Mexico and that if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto.
    I further state that I HAVE CAREFULLY READ AND UNDERSTAND THE FOREGOING RELEASE AND KNOW THE CONTENTS HEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. I understand that this is a legally binding agreement. 

    I have read this Informed Consent/General Release fully understanding its terms, that I give up substantial rights by signing it, and sign it voluntarily.

    DO NOT E-SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT.
    By m eSignature below, I certify that I have read, fully understand and accept all terms of the foregoing statement.  Please signify your acceptance by entering your full name in the box below.
    Please print this page for your records BEFORE you submit it.