Youth First Name* Youth Last Name* Youth Email* Youth Birthdate*
Youth Phone Number* Youth Grade in September 2023:*
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Current School:*
Youth address where they will be living during the school year:*
Address:
City:
State/Province:
Zip:
Are there any accessibility, medical or disability needs or preferences for the youth? For example, if the youth uses closed captions or translated literature or needs extra time to do activities.
Please list all food allergies or dietary restrictions:
Participant Release & Waiver of Liability
In consideration of the opportunity to participate in the activity (Activity) sponsored by Detroit Food Academy (DFA), a nonprofit organization whose registration process requires me to accept this agreement, I hereby agree to the following
Waiver and Release of Liability (Agreement):
1. Waiver and Release of Liability: My participation in the Activity is voluntary and subjects me to the possibility of physical injury (which could be minimal, serious, and/or result in death) and loss of or damage to my property (collectively, Risks). Accordingly, I agree to the following:
a. I hereby release and hold harmless DFA, its officers, directors, employees, agents, volunteers, and contractors (collectively, Releasees) from any claim, demand, loss, liability, damages, and attorney fees and costs whatsoever arising from, related to, or resulting from these Risks (Claims), including those caused by the negligent acts or omissions of any or all of the Releasees.>
b. I recognize the physical exertion involved in the Activity and attest and certify that I am physically fit to compete safely, and I have not been advised otherwise by a health care professional.
c. As between each of the Releasees and me, I will be solely responsible for any and all medical and related bills that I may incur because of any injury, as well as costs related to loss or damage to my property, that I may sustain as a result of my participation in the Activity, including those sustained on the premises where the Activity is conducted and while I am traveling to and from such premises, regardless of the location or mode of transportation.
d. This Agreement shall be binding on my estate, heirs, executors, administrators, successors, and assigns, as well as any other party asserting a Claim on my behalf or on behalf of my estate.
2. General Provisions:
a. I hereby expressly agree that (1) this Agreement shall be governed and construed according to the laws of the state of Michigan without regard to its conflict of laws provisions and (2) any action or proceeding concerning any Claim or the meaning or effect of any provision of the Agreement shall be conducted only in the federal or state courts located in Detroit, Michigan, and that for such purposes, I expressly submit to the jurisdiction of such courts.
b. This Agreement contains the entire understanding between and among the parties concerning these matters. No waiver, modification, or amendment of any of the terms of this Agreement shall be effective unless made in writing and signed by the party to be charged.
c. I hereby expressly agree that if any portion of this Agreement is held invalid, the balance of the Agreement shall nonetheless continue in full legal force and effect./p1>
Consent and Release for Use of Story, Likeness, and Voice
I give permission to Detroit Food Academy to use, without charge and without reservation, photographs and/or video of me for Detroit Food Academy’s website, social media, and any educational, training or promotional electronic or printed material without restriction as to frequency or duration of usage. I waive any rights of action I may have and release DFA from any and all claims I may have arising from use and publication, including any rights to sue for defamation or violation of rights of privacy or rights of publicity.
I warrant that I have read and understand that this Agreement involves my waiver and release of significant rights and my assumption of significant indemnification responsibilities in participating in the Event.
Consent for Communications
I authorize Detroit Food & Entrepreneurship Academy, Inc. or its agents to communicate with the participant through text message, phone calls, email, and internet applications such as Slack.
Consent for Deliveries
Detroit Food Academy will deliver groceries, supplies and kitchen equipment to your student once or twice a month if you are in virtual program OR if in-person program shifts to virtual. This is a NO-CONTACT delivery (porch/stoop drop-off).
By typing your name in the following box, Parent (or participant if over the age of 18), you are signifying you have fully read and understand the Participant Release & Waiver of Liability, Consent and Release for Use of Story, Likeness, and Voice, Consent for Communications, and the Consent for Deliveries.
This acts as your digital signature and is legally binding. Please type the parent or guardian's full name here: Parent Phone:
Parent Email:
Is this the first time your youth is applying to Detroit Food Academy?
Yes
No
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