Application Form

Leadership Program WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT
(For Minor Participants)

In consideration of my child being permitted to participate in the leadership program and related activities at Becky’s Mindful Kitchen (“BMK”), I, the undersigned parent or legal guardian, knowingly and voluntarily agree to the following terms on behalf of myself and my child.

Assumption of Risk

I acknowledge that participation in activities at Becky’s Mindful Kitchen involves inherent and foreseeable risks that cannot be eliminated, even with the exercise of reasonable care and supervision. These risks may result in physical injury, emotional injury, illness, permanent disability, death, or property damage.

Activities may include, but are not limited to: interaction with farm animals (including goats and chickens); treehouse use; timber and outdoor play; uneven or natural terrain; ninja-style obstacles; zip lines; climbing elements; cooking and baking activities (including use of ovens, stovetops, knives, and kitchen tools); fire starting; pizza oven use; hatchets; trail hiking; exposure to insects, animals, weather conditions, dirt, and other natural elements. This list is not exhaustive, and I understand that my child may participate in activities not specifically listed.

I knowingly and voluntarily assume all risks, known and unknown, inherent in or related to my child’s participation in BMK activities.

Release and Waiver of Liability

On behalf of myself, my child, and our respective heirs, assigns, personal representatives, and estates, I hereby release, waive, discharge, and covenant not to sue Becky’s Mindful Kitchen, its owners, officers, employees, volunteers, participants, agents, and all other persons or entities acting on their behalf (collectively, the “Releasees”) from any and all claims, demands, causes of action, damages, or liabilities arising out of or related to my child’s participation in BMK activities, including claims arising from the negligence of the Releasees, to the fullest extent permitted by law.

This release does not apply to claims arising from intentional misconduct.

Indemnification

I agree to indemnify, defend, and hold harmless the Releasees from and against any and all claims, liabilities, damages, losses, costs, or expenses, including reasonable attorneys’ fees, arising out of or related to my child’s participation in BMK activities or my breach of this agreement.

Medical Representation and Health Policy

I represent that my child is physically and medically able to participate in BMK activities and has no condition that would prevent safe participation, or that I knowingly assume all risks associated with any such condition.

I agree not to allow my child to attend a BMK event if they have experienced fever, vomiting, or diarrhea within the preceding 24 hours.

Allergies and Medical Information

I understand and agree that all allergies, medical conditions, or special needs must be communicated directly to Becky Schmooke.

Behavior Expectations

I understand that if my child’s behavior is unsafe, disruptive, or inappropriate and does not resolve after verbal redirection, I may be required to pick up my child immediately. In such cases, my child may not be permitted to return, and no refunds will be issued.

Jurisdiction, Governing Law, and Severability

I agree that any legal action arising out of or related to this agreement or participation in BMK activities shall be brought exclusively in the state in which Becky’s Mindful Kitchen is located, and that the substantive laws of that state shall apply. If any portion of this agreement is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.

Photography and Media Release

I grant Becky’s Mindful Kitchen permission to use photographs and/or video recordings of my child taken during the event for promotional, educational, or marketing purposes, including use on websites and social media, without compensation.

Acknowledgment and Acceptance

By signing this agreement, I acknowledge that I have carefully read and fully understand this document. I understand that this is a release of liability and a legally binding agreement. I understand that by agreeing to this waiver, I may be waiving important legal rights, including the right to sue for negligence. If I am signing on behalf of a minor, I affirm that I have the legal authority to do so and that I consent to the minor’s participation in BMK activities.

I understand that my child may not be permitted to participate in the event if I do not agree to the terms of this waiver.