ReImagine Play - On the MOVE Youth Fitness Class Registration
Sunday, June 28, 2:00 pm Class will be held at Blackstone Square Park
(Corner of Washington and W. Brookline Streets)
South End, Boston, MA 02118
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Parent First Name *
Parent Last Name *
Email *
Your email will be used to send class reminders and ReImagine Play updates
Phone Number *
Child 1- First Name *
Child 1 - Last Name *
Child 1 - Age *
Child 2- First Name *
Child 2 - Last Name *
Child 2 - Age *
Child 3- First Name *
Child 3 - Last Name *
Child 3 - Age *
Liability Waiver and Photo Release
PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT *
ReImagine Play's Class is a fitness and agility class for kids  conducted in an outdoor public park (Class).  In consideration of my minor child being allowed to participate in the Class, I, as the parent/guardian of the child registered above, acknowledge and agree that:  1. There are inherent risks of bodily injury, illness, accidents, death, and property damage and loss involved in participating in fitness and sports activity, including the Class.  2.  On behalf of myself, spouse and child, I knowingly and freely assume all known and unknown risks while participating in the Class, even if arising from the negligence of the Releasees or others; My child’s participation in the Class in voluntary, and I recognize that he/she is participating regardless of these risks.  3. I agree to use, and to direct my child to use, common sense and obey all staff safety instructions to reduce the risk of injury.   4.  I certify that my child is physically able to participate in the Class and that I know of no restrictions, physical impairments, or any other condition, which would limit, in any manner, his or her participation in the Class.  5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the FitNation Ventures, Inc., their officers, directors, officials, agents, owners and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used for Class (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, regarding my child and/or arising from his/her activities, WHETHER ARISING FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE, except for willful misconduct, or otherwise to the fullest extent of the law.  
Required
PHOTO AND MEDIA RELEASE *
I hereby grant permission to FitNation Ventures Inc., dba ReImagine Play, to use, display publicly or to perform, my child's image, likeness, or voice recording on the ReImagine Play web site or in any other official ReImagine Play sites or marketing materials without further notice or compensation. I hereby consent that any such image, likeness, or voice contained in photographs, recordings, and videos are property of ReImagine Play, which shall have the right to print, reprint, publish, copy, vend, perform or represent publicly, or create derivative works based on and using the image, likeness, or voice depicted in such photograph, film, or sound recording as it may desire free and clear of any claim whatsoever on my part or the part of my child.  I also understand that once my child's image, likeness, or voice recording is published on a web site, it can be downloaded by any computer user. Personal information, such as your child's full name, parent/guardian’s names, addresses and telephone numbers will never be published. If a child’s name is used with a photograph, film, or sounds recording it will be in the form of a first name and last initial. For example, student Lisa Smith may be listed as, “Lisa S.”  I agree to indemnify, defend and hold the Releasees harmless from and against any and all claims and liabilities resulting from the publishing.
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