State of Florida
Child’s Full Name: ____________________________________________
Parent/Guardian Full Name: ____________________________________
Address: _____________________________________________________
Phone: _______________________ Email: _________________________
1. Voluntary Participation
I, the undersigned parent and/or legal guardian (“Parent/Guardian”), hereby give permission for the above-named child (“Participant”) to participate in the Decorum Etiquette Program (“Program”). I understand that participation is voluntary.
2. Parental Responsibility and Transportation
I understand that I am solely responsible for my child’s transportation to and from the Program. I agree to pick up my child promptly at the designated dismissal time. The Program is not responsible for supervision before or after scheduled program hours.
3. Code of Conduct and Dismissal Policy
Participants are expected to behave respectfully and follow all Program rules. The Program reserves the right, at its sole discretion, to dismiss any participant for disruptive, inappropriate, unsafe, or disrespectful behavior. If a participant is dismissed for misconduct, no refund will be issued.
4. Program Content Acknowledgment
I understand that certain materials and instruction within the Program may be Christian-based in nature.
5. Assumption of Risk
I understand that participation in group instruction and related activities involves inherent risks, including but not limited to accidental injury, illness, emotional distress, or unforeseen incidents. I knowingly and voluntarily assume all risks, both known and unknown, arising out of or related to my child’s participation in the Program.
6. Waiver and Release of Liability
To the fullest extent permitted by the laws of the State of Florida, I, on behalf of myself and my child, hereby release, waive, discharge, and hold harmless Decorum, its owners, directors, instructors, employees, volunteers, agents, representatives, affiliates, and facility providers (collectively “Released Parties”) from any and all claims, demands, actions, causes of action, damages, losses, liabilities, costs, or expenses (including attorney’s fees) arising out of or related to my child’s participation in the Program, including but not limited to claims arising from negligence.
7. Indemnification
I agree to indemnify and hold harmless the Released Parties from any claims, damages, liabilities, costs, or expenses (including reasonable attorney’s fees) arising from my child’s participation in the Program or from any damage or injury caused by my child.
8. Medical Authorization and Disclosure
I certify that my child is physically and mentally able to participate. I agree to disclose any relevant medical conditions, allergies, behavioral issues, or special needs that may require accommodations. In the event of an emergency, I authorize Program staff to obtain emergency medical treatment for my child and accept full financial responsibility for any medical expenses incurred.
9. Payment and Refund Policy
All program fees are due as stated at the time of registration. Registration fees and deposits are non-refundable unless otherwise stated in writing. No refunds will be issued for voluntary withdrawal, missed courses, dismissal due to misconduct, or failure to attend. The Program reserves the right to cancel or reschedule sessions due to insufficient enrollment, instructor illness, facility issues, or unforeseen circumstances. In such cases, a rescheduled session or credit may be offered at the Program’s discretion. By enrolling, I acknowledge and agree to this Payment and Refund Policy.
10. Photo, Video, and Media Release
I grant permission to Decorum Etiquette Program to photograph, video record, and/or capture my child’s image, likeness, or voice during Program activities. I authorize the use of such media for promotional, educational, website, social media, advertising, or marketing purposes without compensation. I understand that media may be published publicly, and once published online, the Program cannot control further distribution. Personally identifying information will not be disclosed without additional consent. I release the Program from any claims related to the use of such media, including claims for invasion of privacy or misappropriation of likeness. If I do not consent, I must provide written notice prior to participation.
11. COVID-19 and Communicable Illness Acknowledgment
I acknowledge that participation may involve exposure to communicable illnesses, including but not limited to COVID-19, influenza, RSV, or other viral or bacterial infections. I voluntarily assume all risks related to exposure or illness arising from participation. I agree not to send my child if they are experiencing symptoms of illness, to notify the Program if my child is diagnosed with a communicable illness that may affect others, and to follow all health and safety procedures implemented by the Program. To the fullest extent permitted by Florida law, I release the Program from any claims related to illness allegedly arising from participation.
12. Governing Law and Venue
This Agreement shall be governed by and interpreted in accordance with the laws of the State of Florida. Any legal action arising out of this Agreement shall be brought exclusively in a court of competent jurisdiction located within the State of Florida.
13. Severability
If any provision of this Agreement is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.
14. Acknowledgment of Understanding
I have carefully read this Parent/Guardian Consent, Assumption of Risk, Waiver and Release of Liability Agreement. I understand that I am giving up substantial legal rights on behalf of myself and my child. I sign this Agreement freely and voluntarily.
Parent/Guardian Signature: ___________________________________
Printed Name: _______________________________________________
Date: _______________________________________________________
Emergency Contact Name: _____________________________________
Emergency Contact Phone: _____________________________________