READ CAREFULLY BEFORE SIGNING
In consideration for my child’s participation in Kujichagulia – Madison Center for Self Determination, Inc. program I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Kujichagulia – Madison Center for Self Determination, Inc., and their respective employees, agents, representatives and volunteers (hereinafter referred to as “RELEASEES”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child, or to any property belonging to me, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES or otherwise, while participating in the Program, or while in, on or upon the premises where the Program is being conducted.

IDENTIFICATION AND ACKNOWLEDGMENT OF RISK
I am fully aware of the risks and potential hazards connected with participating in the Kujichagulia – Madison Center for Self Determination, Inc. including but not limited to, the risk of data mining, phishing, viruses, malware, data breach of online information cyberbullying, exploitation, victimization, cyber stalking, online grooming, cyber predators, image replication, and I hereby elect to voluntarily participate in the Program, and engage in such activity knowing that the activity may be hazardous to my child and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, that may be sustained by my child, or any loss or damage to property owned by me, as a result of my child being engaged in such an activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise.

CONSENT TO LIMITED DATA COLLECTION
I hereby give permission for the Kujichagulia – Madison Center for Self Determination, Inc., to collect information from me and my child through an online platform, for the limited purpose of Program registration and participation. I understand that this information will not be shared with any third-party, unless otherwise required by the third-party platform provider for participation.

CONSENT TO PHOTOGRAPHY AND RECORDING
I further hereby authorize the Kujichagulia – Madison Center for Self Determination, Inc.to photograph and video/audio record my child during the Program, and use or distribute any photograph, audio or video recording (“Materials”) related to Program activities that my child is depicted in. I also authorize use of these Materials for publication in a brochure, on Kujichagulia – Madison Center for Self Determination, Inc. websites, or other Kujichagulia – Madison Center for Self Determination, Inc. promotional material. Materials may also be distributed to other Program participants, or the public for educational purposes, including but not limited to a Program group photograph of all participants.
RELEASE AND WAIVER OF LIABILITY
I HEREBY EXPRESSLY RECOGNIZE AND ASSUME ALL RISKS ASSOCIATED WITH MY CHILD’S PARTICIPATION IN THE PROGRAM AND VOLUNTARILY RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE AND HOLD HARMLESS THE RELEASEES. I AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage or costs, including court costs and attorneys’ fees, that may incur due to my child’s participation in the Program WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise. It is my express intent that this Participant Release, Consent and Waiver of Liability shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEES. I hereby further agree that this Participant Release, Consent and Waiver of Liability shall be construed in accordance with the laws of the State of Wisconsin.

IN SIGNING THIS PARTICIPANT CONSENT, RELEASE AND WAIVER OF LIABILITY, I ACKNOWLEDGE AND
REPRESENT THAT I have read the foregoing, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducement, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent and I am the parent or guardian of the child participant, and I execute this Participant Consent, Release and Waiver of Liability for full, adequate and complete consideration, fully intending to be bound by same.