Mobile Memory Cafe – Stoneridge

PARTICIPANT LIABILITY WAIVER
I desire to participate in programs and activities with Dementia Together. As a pre-requisite to participation and to protect Dementia Together, I hereby freely, voluntarily and without duress execute this Release:

Release and Waiver. I hereby release and forever discharge and hold harmless Dementia Together, its directors, officers, trustees, employees, volunteers and agents and their successors and assigns (each a Released Party) from any and all liability, claims and demands which I or my heirs, assigns, next of kin or legal representatives may have or which may hereinafter accrue with respect to any bodily injury, personal injury, illness, death or property damage or other losses of any kind which arise or may hereafter arise from or is in any way related to my Activities with Dementia Together, whether caused wholly or in part by the negligent (both active and passive) acts or omissions of any Released Party, provided that this release shall apply with respect to the gross negligence of any Released Party.
By signing this Release, I knowingly assume the risk of injury, harm and loss associated with all Activities undertaken with Dementia Together. I also understand that the Released Agents do not assume any responsibility for or obligation to provide financial assistance or other assistance to Participant, including but not limited to medical, health or disability assistance in the event of injury, illness, death, or property damage.

Medical Treatment. I hereby release and forever discharge Dementia Together and the Released Parties from any claim or action whatsoever arising from or related to any first aid, treatment or service rendered by any of the Released Parties in connection with or related to Activities I participate in with Dementia Together.
Dementia Together Activities. If the Participant is less than 18 years of age, or living with cognitive decline that makes understanding of this document difficult, the Participant and the parents or care partners also hereby release and forever discharge the Released Parties from any claim whatsoever which arises or may hereafter arise on account of the decision by any representative or agent of Dementia Together and the Released Parties to exercise the power to consent to medical or dental treatment as such power may be granted and authorized in a parental or care partner Authorization for Treatment.

Assumption of the Risk. I hereby expressly and specifically assume the risk of injury or harm that may arise due to my participation in the Activities and release Released Parties from all liability for any loss, cost, expense, injury, illness, death, or property damage resulting directly or indirectly from the Activities.

Photographic and Recording Assignment. I hereby grant and convey to Dementia Together all right, title and interest, including all rights under copyright law, in any and all photographs and video or audio recordings of or including my image or voice, taken during any Activities (Recordings). For the avoidance of doubt, this assignment of rights shall include the right for Dementia Together to reproduce, create derivative works of or publicly perform or display Recordings for social media, outreach and awareness education, marketing, service development, fundraising and research purposes. I acknowledge that I shall not be entitled to any royalties or other consideration for such use.

Other. I, the Participant, expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the state where the Activities take place. I further agree that in the event any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining clauses or provisions of this Release, which shall continue to be enforceable. Further, a waiver of a right under this Release does not prevent the exercise of any other right. This Release shall survive and the expiration or termination of my status as a Participant for Dementia Together.
I hereby acknowledge the receipt and adequacy of consideration received by me in return for the execution of this Release.

PARTICIPANT INFORMATION SHARING AND MEMORIAL RELEASE
I desire to participate in programs and activities with Dementia Together. As a pre-requisite to participation and to protect Dementia Together, I hereby freely, voluntarily and without duress execute this Release:

Information Sharing and Memorial Authorization.
I hereby authorize Dementia Together, its directors, officers, trustees, employees, volunteers, and agents (each a Released Party) to:

Share my name and email address with other participants in Dementia Together programs and activities for the purpose of fostering community, encouraging mutual support, and reducing isolation.
In the event of the death of my loved one living with dementia, post their name and a link to their publicly available online obituary on the Dementia Together website (www.dementiatogether.org) as a way to honor their memory and acknowledge their participation in the community.
I understand that this information will not be shared publicly beyond the intended purposes and that I may revoke this authorization at any time by providing written notice to Dementia Together. I understand that revoking this authorization will limit the effectiveness of support groups, classes, workshops, and life enrichment activities.

Assumption of Responsibility.
I understand that participation in Dementia Together programs is voluntary and that I am responsible for the information I choose to share. I release and hold harmless the Released Parties from any liability that may arise from the authorized sharing of my information as described above.

Other.
I, the Participant, expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the state where the Activities take place. I further agree that in the event any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining clauses or provisions of this Release, which shall continue to be enforceable. Further, a waiver of a right under this Release does not prevent the exercise of any other right. This Release shall survive and continue in effect after my participation in Dementia Together programs has ended.

I hereby acknowledge the receipt and adequacy of consideration received by me in return for the execution of this Release.