Billing and payment processing is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, in accordance with this registration. The phrase "8882448044 ONLINE REG FEE" or "MSI*THECENTERFORURBANAGR" will appear on your bank or credit card statement. Any returned payment will be assessed a $35.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.
In consideration for being accepted by FAIRVIEW GARDEN/THE CENTER FOR URBAN AGRICULTURE to participate in the below described program, we (I) [and on behalf of our (my) child-participant] do hereby release, forever discharge and agree to hold harmless FAIRVIEW GARDEN/THE CENTER FOR URBAN AGRICULTURE and the staff thereof from any and all liability, claims or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the Fairview Gardens Youth Programs.
Furthermore, we (I) [and on behalf of our (my) child-participant] hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation, including tree climbing, and/or work activities involved therein. I authorize the staff of Fairview Gardens to act for me according to their best judgment in any emergency requiring medical attention. I understand that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment, regardless of whether or not my medical insurance would cover such charges and fees. I further understand that I am required to maintain and carry accident insurance coverage for the child listed on this application, and verify that the coverage information that I have provided is accurate and true. I have no knowledge of any physical impairment that would be affected by the above named camper’s participation in the camp program as outlined in the brochure. I also understand that the camp retains the right to use for publicity and advertising purposes, photographs of campers taken at camp. Further, authorization and permission is hereby given to said program to furnish any necessary transportation, food and lodging for this participant.
The undersigned further hereby agree to hold harmless and indemnify said FAIRVIEW GARDEN FARM/THE CENTER FOR URBAN AGRICULTURE, its administrators, employees, for any liability sustained by any other participant as the result of the negligent, willful or intentional acts of this participant, including expenses incurred attendant hereto.
We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said program.
Photo and Video Release
I hereby authorize The Center for Urban Agriculture at Fairview Gardens (CUAFG) and those acting pursuant to its authority to photograph, video tape, or use any other electronic method of recording my likeness and/or voice to be used at CUAFG’s discretion in Fairview Gardens publications and/or web sites. The photographs and/or video footage will not be digitally manipulated to change its content.
I hereby give CUAFG the absolute right and permission, without restrictions, to make, copyright, and/or use, re-use, or publish said photographs/video footage of me in which I may be included in whole or in part, and waive any right to inspect and/or approve the finished printed materials, videos and/or web sites where my image appears. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.
I release CUAFG and those acting pursuant to its authority from liability for any violation of any personal or proprietary right I may have in connection with such use. I understand that all such recordings, in whatever medium, shall remain the property of CUAFG.
I waive any right to compensation for my appearance in these printed documents, videos or web sites in any and all future uses of the photographs and/or video footage.
I have read and fully understand the terms of this release.