I, (identified above by name as parent/legal guardian), the undersigned, hereby authorize The Institute, its officers, staff, agents, employees and volunteers to dismiss my child/children, (named above), unaccompanied by me, the undersigned, or an authorized guardian and/or caregiver from the Innovation Institute, within suite 300, at 288 Walnut Street, Newtonville, MA 02460. This includes unaccompanied dismissal from the Innovation Institute’s suite 300 premises (e.g., the lobby of 288 Walnut Street, Newtonville, MA 02460 and its environs) to wait for pick up by private of public transportation or for unaccompanied departure for another destination.
In consideration of permission for unaccompanied dismissal, I do hereby, for myself, my heirs and assigns, and on behalf of my child/ward, and for his or her heirs and assigns, release and agree to indemnify and hold harmless The Innovation Institute, it officers, staff, agents, employees and volunteers from any and all liability, loss, claim, demand, action, or cause of action which arises or may arise or be occasioned in any way by such dismissal.
I have read the above information and I understand and agree to its content. I am fully aware of the legal consequences of signing this agreement and do so voluntarily.