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Miriam's Center Waiver

  • Aleph Institute, Inc. - Miriam Center at Shifra Program

    Assumption of Risk, Waiver, and Release from Liability ("Release Form")
  • This Release Form shall remain in effect until otherwise noted.
    This Release Form is entered by Aleph Institute Inc. Miriam Center at Shifra program and Miriam's Motherhood Center and the undersigned Parent or Legal Guardian. By entering the Motherhood Center located at 2008 Murray Ave., the undersigned acknowledges all the following terms:

    1. Assumption of Risk: Any activity that involves motion carries with it a possibility of physical injury. I am choosing to use the facilities at the Motherhood Center at my own risk. I assume full responsibility for all risks for myself and/or any minor children for which I am the parent, legal guardian or otherwise responsible that may arise from using the facilities at the Motherhood Center or from participating in activities at the Motherhood Center including, but not limited to: adult fitness classes, the playroom, programs and babysitting services ("Activities"). I waive all claims for injury, serious injury and death to persons arising from participation in Activities whether arising from negligence or carelessness on the part of the persons or entities being released and other participants or arising from dangers or defective equipment at the Motherhood Center.

    2. Insurance: I understand that I am solely responsible for any medical, health, or personal injury costs relating to my use of the Motherhood Center and its facilities. I understand that I am strongly encouraged to have a medical physical exam and purchase health insurance prior to the use of the facilities.

    3. Acknowledgement of Policies and Procedures: I acknowledge that I have read and agree to all of the policies and procedures relating to the use of facilities at the Motherhood Center. I agree to comply with all rules, regulations, and policies. I understand the Motherhood Center reserves the right to revoke or terminate my use of the facilities for any violation of rules, regulations, or policies.
    4. Photography and Publicity: The Motherhood Center reserves the right to photograph or take videos of guests within the Premises. I authorize and permit the Motherhood Center to use such photograph/video display and/or use for any purpose, including sharing on social media, advertising, publicity, and public relations.

    5. Release, Indemnify, and Defend: I hereby release, waive, discharge, and hold harmless the Motherhood Center and all its employees/volunteers past or present from any claims, suits, liabilities, judgements, costs and expenses for any property damage, loss or theft of personal items, personal injury or illness, death, or other loss arising from the use of the Motherhood Center.

    6. Waiver: I hereby waive any protections afforded by any statute or law in any jurisdiction whose purpose and/or effect is to provide that a general release shall not expend to claims, material or otherwise which the person giving the release does not know or suspect to exist at the time of executing the release. I am releasing unknown future claims.

    7. Misbehaving Rule: Staff have the right to expel any child/children and parents that misbehave or fail to comply with rules. Misbehavior includes bullying, hitting, kicking, fighting, explicit use of language, or use of violence within the premises.

    8. Parents/Guardians: I have the authority to enter into this agreement for myself as well as for my minor child or any child of which I am the assigned/legal representative. I agree to monitor my child/children at all times during their entire visit, I take full responsibility for any injuries/accidents that occur to my child/children.

    9. Arbitration: Al parties to this agreement agree to mediate through Beis Din, in good faith, any dispute prior to initiating arbitration. If mediation fails, any controversy or claim arising out of or relating to this Release Form shall be settled by arbitration administered by the American Arbitration Association, and judgment on the award rendered by the arbitrators) may be entered in any court having jurisdiction thereof. The prevailing party will be responsible for all fees, including attorney fees.

    For Babysitting Services:
    10. I, the parent or guardian of the child or children listed below, am leaving my child or children with the babysitting service at the Motherhood Center and hereby release and waive against all claim of The Motherhood Center, its agents, employees, volunteers, and representatives, from injuries or damages arising from injuries relating to my child's or children's participation at the babysitters at the Motherhood Center. I further agree to indemnify, save and hold indemnities harmless from any loss, liability, attorney fees, damage or cost that they (or any of them) may incur out of or related to the babysitting services offered by the Motherhood Center.

    11. In the case of a medical emergency or behavioral issue, I understand that the babysitting service will act on my behalf if attempts have been made to contact me and I was not available.

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