Lemonade Waiver Forms

THANK YOU for submitting your Request for a Lemonade Stand Kit! One of our staff members will be in touch very soon to arrange a pick up or drop of your kit.

You will need to review two additional items, which include a Participant Waiver of Liability and a Photo/Media Authorization. If you would like to go ahead and submit those online, please do so below. Otherwise, you can complete them when you pick up your Lemonade Stand Kit.

Participation of Waiver of Liability and Photo/Media Authorization

* Indicates required field

This agreement releases Kellin, PLLC and/or the Kellin Foundation (herein referred to as the Agency) from all liability relating to injuries or damage that may occur by the acceptance of items and goods provided, or from participating in activities connected with the organization. I release the Agency from any responsibility of mechanical failure that may occur from use of the donated items or from activities that I choose to participate in. By signing this agreement, I agree to hold the Agency entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence. I also acknowledge the risks involved in accepting donated goods and products. I swear that I am participating voluntarily, and that all risks have been made clear to me. By signing below, I forfeit all right to bring a suit against the Agency for any reason. In return, I will receive the goods and services that were requested, and have the opportunity to participate in activities connected to the organization. I will also make every effort to obey safety precautions. I have had the option to ask questions. My response below indicates that I fully understand and agree to the above terms. *

Yes, I agree No, I do not agree

By signing below, I irrevocably grant permission to the Kellin Foundation and its employees, agents, partners, and advertisers, to record and use my name, image, voice, statement and/or writings including any and all photographic/still images and video or audio recordings made by Kellin, PLLC and the Kellin Foundation and its assignees(s), advertisers, customers, agents, and successors for unrestricted use in print and electronic mediums including but not limited to publications, displays, websites, social media, advertisements, recruitment, and promotions, without notifying me. I voluntarily waive any right to inspect/approve the finished photographs that may be used in conjunction with them now or in the future, whether it is known to me or unknown to me. I also waive any right to royalties or any other compensation arising from or related to the use of the photograph(s) or other media. I am 18 years of age or older or I am the parent/legal guardian for the minor child listed below, and I am competent to sign this release. I have read the release before signing below, and I fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding matters of this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. *

Yes, I agree No, I do not agree

I understand that as part of my participation in this event that I will provide all of the supplies for this activity, other than what is given in the Lemonade Stand Kit, with all proceeds being returned in full to the Kellin Foundation by April 30, 2017. *

I understand and agree

Name of Legal Guardian *

First

Last

Name of Child *

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Last

Submit