Date of Class / Event *

MM

DD

YYYY

Parent's Name *

First Name

Last Name

Allergies or Special Requirements *

None

Describe below

Is Anyone Other Than You or Emergency Contact Authorized to Pick Up the Child(ren)? *

No

Yes

Agreement for Waiver, Release, Indemnification & Assumption of Risks for Minor Children - I, the above named Parent, in consideration for participating in one or more cooking programs offered by Mindful Cuisine, LLC (“Mindful Cuisine”) to be held from time to time (the “Cooking Program”), hereby agree as follows (you must agree in order for your child or children to participate in the Cooking Program): - I acknowledge and understand that participation in Cooking Programs carries with it certain inherent risks, hazards and dangers that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from minor injuries such as cuts and burns as well as major injuries such as eye or back injuries to catastrophic injuries. I am voluntarily allowing my child or children to participate in Cooking Programs with knowledge of the risks, hazards and dangers and I knowingly assume all such risks, hazards and dangers. I VOLUNTARILY ASSUME SUCH RISKS for my child or children. In consideration for attending or participating in the Cooking Program, I hereby agree to release and forever discharge Mindful Cuisine and its agents, contractors, employees, officers, directors, successors, assigns, and all other persons or entities on its behalf (collectively, “Affiliated Parties”), from any and all claims, actions, damages, liability, costs or expenses and attorney fees which are related to, arise out of, or are in any way connected to my child’s or children’s participation in the Cooking Program activities, use of equipment or property supplied by Mindful Cuisine, whether or not such claims, actions, damages, liability, costs or expenses are caused by the negligence of Mindful Cuisine or an Affiliated Party. I agree to hold harmless and indemnify Mindful Cuisine and the Affiliated Parties from any and all liability for damage to any third party resulting from my child’s or children’s participation in the Cooking Program. By this Agreement, I intentionally surrender and waive any right to sue or exercise any legal right to seek damages from Mindful Cuisine or the Affiliated Parties. I give my consent and permission to Mindful Cuisine to obtain, on behalf of my child or children, any emergency medical treatment in case of sickness, accident or injury and to secure such medical attention at my expense. This Agreement will be effective and binding upon my heirs, agents, personal representatives and assigns. I HEREBY WAIVE THE RIGHT TO A JURY TRIAL. I have carefully read the foregoing and acknowledge that I understand and agree to all of the above terms and conditions. I have had the opportunity to ask questions regarding this Agreement and the effect of the same. I am aware that by indicating my agreement, I assume all risks and waive and release certain substantial rights that I may have or possess. *

Agree