I am the parent or legal guardian of ____________________, a minor (“Participant”). I agree that the Participant may participate in the Kilometer Kids program, the Atlanta Track Club’s incentive-based running program. The purpose of the program is to increase the Participant’s activity/fitness level. I understand that during the program, the Participant will be involved in outdoor physical activities. Physical reactions to exercise may include heat-related illness, abnormal heartbeats and blood pressure and, in rare instances, events such as heart attacks.
I acknowledge that Kilometer Kids, the Atlanta Track Club, and their affiliates are not responsible for investigating, selecting, or approving any of the volunteer coaches involved in the activities at any particular site, including determining whether a volunteer coach is (a) experienced or knowledgeable regarding physical fitness or techniques for improving physical fitness of children, or (b) capable of providing a safe environment for the children engaged in the program. It is specifically acknowledged that the Site Coordinator is responsible for conducting any background check or other proper investigation of any potential volunteer coach. Recognizing the Site Coordinator’s responsibility, the risks of the program, and in consideration for allowing the Participant to participate in the program, I hereby release, discharge and agree to hold harmless, and to indemnify Kilometer Kids, its owners, directors, officers, contributors, sponsors, employees, contractors, agents and assigns against and from any causes of action, claims, demands, damages, costs, loss of services, expenses, compensation, all consequential damages and attorneys’ fees (regardless whether pursuant to the laws of any county, state or country) claimed by, through or on behalf of me or the Participant related directly or indirectly to the program, and specifically including any and all claims for personal injuries sustained while participating in program activities without regard to negligence or negligent conditions.
I hereby grant Kilometer Kids, and all assigns, licensees, successors in interest, legal representatives, employees, consultants, and those acting with permission or authority of the aforementioned parties, the absolute, irrevocable and unrestricted right to use photographs, videos likeness and audio (including without limitation all originals, negatives, prints and transparencies or any duplicates or reproductions of the foregoing) that have been or will be taken of the Participant (collectively, “Images”), in which the Participant may be included with others, to copyright the same, in the name of Kilometer Kids or otherwise; to use, re-use, publish and republish the same in whole or in part, individually or in conjunction with other photographs and videos, and in conjunction with any printed matter, in any and all media now and hereafter known, and for any purpose whatsoever; and to use my name in connection herewith.
I hereby release and agree to hold harmless Kilometer Kids and all aforementioned entities, from any damages or liability relating to or arising from any use of or modification, alteration, distortion or other change to any of the Images and/or information gathered, unless it can be proven that such reproduction were maliciously caused, produced and published for the sole purpose of subjecting Participant to conspicuous ridicule, scandal, reproach, scorn and indignity. I hereby waive any claims I may have based on any usage of the Images, information gathered, or works derived thereof, including but not limited to claims for either invasion of privacy or libel. I represent, warrant and agree that the Participant will not disaffirm or disavow this release on the ground that the Participant was a minor on the date it is executed or any similar grounds whatsoever.
In order to assure that the Kilometer Kids program is of high quality and has a positive impact on your child(ren), the program engages in ongoing evaluation and quality improvement efforts. Program participants may be invited to fill out an online or paper survey at the beginning and end of each program cycle. These surveys measure the impact of the program on your child’s development and captures your child’s experiences within the program, allowing us to make critical improvements to meet their needs. Participation is completely voluntary. You and your child have the right to terminate their survey participation at any time or to refuse their participation entirely without jeopardy to their status in the Kilometer Kids program.
All information obtained from your child on the survey will be kept confidential and will be used by staff to increase the quality of the program. Program managers, and possibly external evaluators, will also have access to the data so that they can continue to improve the program and support your child’s individual needs. Data are gathered and analyzed through online platform called Hello Insight and UpMetrics. Your child’s name will not be associated with their data in Hello Insight or UpMetrics. Data within this platform are kept confidential in a secure database. Atlanta Track Club’s data evaluation partners will never use your child’s name for any reason related to this data, and all data displayed through this system will highlight combined or group results.
If you agree that your child can take the survey, nothing needs to be done. If you choose not to have your child participate, inform the evaluators that your child(ren) are opted out of the data collection process. If you have questions regarding this process or the surveys themselves, you may contact firstname.lastname@example.org.
I expressly agree that this consent is intended to be as broad and inclusive a release of liability as permitted by applicable law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I hereby warrant and represent that I am 18 years old or older; I have carefully read this consent and agree to its terms and conditions, that before signing this agreement I had the chance to ask questions; and I am aware that by signing this consent, I assume all risks and waive and release certain substantial rights that I and participant may have or possess against Kilometer Kids. To the extent permitted by applicable law, I hereby irrevocably and unconditionally waive trial by jury in any legal action or proceeding related to this agreement.