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National Stuttering Association

Purple and turquoise starburst with the letters NSA in the middle.

Parent Authorization, Waiver, and Release Form

Mentors are required to fill out the application and background criminal (not credit) check below before being assigned to a Mentee.

  • I understand that by registering for and participating in the NSA Mentoring Program an NSA event (“NSA Event”), I am agreeing to the terms of this Authorization, Waiver & Release both on behalf of myself and my child(ren) who will participate. I give permission for my child(ren) to participate in activities associated with the "NSA Event". I understand that "NSA Event" will be run by NSA Volunteers who have been background checked and who will oversee these program to the best of their ability, but that these volunteers and employees shall not be held liable for injury or harm to my child(ren) of any kind which may occur whether or not the injury or harm occurs before during or after the event or on the property of a third party. A parent or legal guardian of the minor has registered the minor thereby agreeing to this Authorization, Waiver & Release of Liability form. I (and my children) have fully reviewed the "NSA Event". By participating in the "NSA Event", intending to be legally bound, I hereby agree to release from liability and to fully indemnify and hold harmless The National Stuttering Association (including, but no limited to, its officers, directors and employees) and the NSA Volunteers who are acting as NSA Event personnel. This waiver and release are for any and all liability, including, but not limited to, personal injuries (including death), costs, expenses, property losses or damages occasioned by, or arising in connection with, any activity related to any and all NSA Events. Any controversy or claim arising out of or relating to this agreement, shall be settled by arbitration administered by the American Arbitration Association. Arbitration shall take place in the state of New York. Judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. This Agreement shall be governed by and shall be construed in accordance with the laws of the State of New York. If any provision or provisions of this Agreement shall be held to be invalid, illegal, unenforceable or in conflict with the law of any jurisdiction, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.
  • I have read this Authorization, Waiver & Release form in its entirety, fully understand its terms, and have agreed to its terms freely and voluntarily without any inducement, assurance, or guarantee being made to me. I understand that for my NSA Event participation is a complete and unconditional release of liability to the greatest extent allowed by law of the state for all persons I have registered, including my minor child(ren).