Permission for Observation

I hereby grant permission to Saint Joseph's University ("SJU") and the Kinney Center to allow observation of my participant child during Kinney Center program hours by therapists, teachers and other qualified professionals working with or otherwise gauging the progress of my child; by undergraduate and graduate students of SJU studying autism; and, incidentally, by parents, guardians, therapists, teachers and other qualified professionals working with or otherwise gauging the progress of another participant child. All observers are bound by the Kinney Center's Confidentiality policy and may not share observations with parties who are not involved with the original Observation Request.

In addition, I, for myself and for Participant, hereby release, waive and forever discharge SJU and Kinney Center, its and their present and former employees, shareholders, owners, directors, trustees, officers, officials, affiliates, insurers, licensees, subsidiaries, consultants, independent contractors, attorneys, representatives, successors and assigns, and their respective executors, heirs and administrators (collectively, the "Releasees") from all causes of actions, liabilities, costs, attorney's fees and claims, in law or in equity, known or unknown, foreseen or unforeseen, accrued or unaccrued, future or contingent, that Participant or I ever had, now has, may have or may claim to have in the future that arise out of or are related to the aforementioned observation, including, without limitation, any and all claims for property damage, personal injuries, special, incidental, indirect or consequential damages of any kind, or punitive damages or other claims arising therefrom or related thereto (collectively referred to herein as "Claims"). I, for myself and for Participant, covenant not to sue the Releasees, nor to participate in any claim or action of any nature against Releasees arising out of or relating to the observation.

I acknowledge that I have read and fully understand this form and further understand and agree that my waiver of Claims and release from liability herein will be binding on the Participant, me, my legal representatives and my heirs, successors and assigns.

Therefore, I the undersigned Parent(s) or Legal Guardian(s) of Participant, hereby affirm, and, on behalf of Participant, agree to be bound by the above-stated Waiver and hereby acknowledge that I/We has/have read the Waiver and are satisfied that it is fair and equitable for the benefit of the Participant; and I/we will not revoke or rescind this Waiver.

Participant's Name(s):

 
##1st Child First Name## ##1st Child Last Name##
##2nd Child First Name## ##2nd Child Last Name##
##3rd Child First Name ## ##3rd Child Last Name##