Program Participant’s Name:


In consideration of the HUB-Arts and Cultural Center providing program/activity in which the above named will participate and other good and valuable consideration the receipt and sufficiency of which is being hereby acknowledged, the undersigned hereby releases The HUB, their agents, servants, and employees of and from any and all liability, claims, demands, actions and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the undersigned, or any property of the undersigned or undersigned’s child, while participating in any program or activity conducted by The HUB or while on the premises where such activities are being conducted.


The undersigned being duly aware of the risks inherent in participating in any activities described above, hereby voluntarily assumes all risks of loss, damage, or injury, including death, that may be sustained by the undersigned while participating in any class or activity conducted by The HUB.


This release will be binding on the heirs, next of kin, executors, administrators and personal representatives of each of the undersigned.


IN CASE OF EMERGENCY, I hereby give permission for The HUB to seek medical attention for my child if a medical emergency should arise. I understand, however, that every effort will be made to contact me in cause of such an emergency and, if possible, before any such medical treatment is administered.



In signing the foregoing release, the undersigned hereby acknowledges and represents:


(a) That he or she has read the foregoing release, understands it, and signs it voluntarily;


(b) That he or she is 18 years of age or older and of sound mind.



Dated ______________                                [Print Name]_______________________________________________





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