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To be completed by the Parent/Guardian of the participant

I/We, [Parent/Guardian's name listed below], in exchange for my/our child being given the opportunity to participate in Table Tennis Clinics in Washington D.C. Jamatkhana (the “Activity”), hereby give consent and permission for my/our son/daughter, [Son/Daughter's name listed below], (“the Participant”) to attend and participate in the Activity from November 12, 2016 to December 10, 2016.

I/We, on behalf of myself/ourselves, the Participant, and my/our heirs, successors, assigns, and any other persons or entity claiming through or under any of them, agree to RELEASE, INDEMNIFY, and HOLD HARMLESS His Highness Prince Aga Khan Shia Imami Ismaili Council for the United States of America (the “Council”), its regional/local councils, boards, portfolios, members, staff, volunteers, and agents, including the organizers, counselors and staff associated with the Activity (collectively, the “Indemnitees”) from and against any and all losses,  claims, damages, causes of action, liabilities, costs, and expenses which may be asserted against the Indemnitees, if any, of every nature whatsoever, known or unknown, which arise out of or are connected with (1) any damages to person or property as a result of the Participant’s participation or any other person's participation in the Activity; (2) any injury or death, including that arising, in part or whole, from the sole or contributory negligence of the Indemnitees, occurring during or related to the Activity and/or any travel which participation in the Activity may involve; and (3) any policies, procedures, conduct, or negligent act or omission of the Indemnitees. 

I/We, on behalf of myself/ourselves, the Participant, and my/our heirs, successors, assigns, and any other persons or entity claiming through or under any of them, hereby consent to any medical or surgical treatment which the Participant may need and which arises in connection with the Activity; provided, however, nothing contained herein shall be deemed an obligation to provide any such medical or surgical treatment. I/we understand that the Council and Indemnitees do not carry healthcare insurance that covers the Participant and therefore, I/we are solely responsible for the cost of all medical and surgical treatment.

Any controversy or claim arising out of or relating to the Activity or this Consent & Release Form shall be settled by binding arbitration administered by the His Highness Prince Aga Khan Shia Imami Ismaili Conciliation and Arbitration Board for the United States of America, and its decision shall be final and binding on all parties.  I/WE HAVE READ AND VOLUNTARILY SIGN THIS CONSENT & RELEASE FORM AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. 

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