I understand that I am responsible for my children and agree to remain on site during groups. If I do not stay
on site, I agree to be reachable at all times. I recognize that Cornerstone of Hope is not responsible for
providing medication to my child, I have informed Cornerstone of Hope of any and all allergies, health
concerns or behavioural challenges applicable to my family. I will hold medication for my child (only
exception is for Epipen) and agree to be responsible for administration of same. I agree to not attend a group
session if my child is sick with a communicable disease.
I Do Not Consent to the photographing, by way of video, photo, digital camera, or otherwise of myself and/
or my child/ward and Do Not Consent to the use of such images or video to be used by Cornerstone of
Hope (“Cornerstone”) in promotional material, publications or advertisements, including quotes or
pictures in print or broadcast publications (the “Material”). I release and forever discharge
Cornerstone, their directors, officers, employees, and representatives from any action, cause of action or
claims arising to date or in the future in which I, have or may have by reason of any cause matter or thing
whatever existing or arising in connection with the use of the Material.
I hereby certify that I have carefully read this waiver and media use release agreement and understand
the contents thereof, and that I have executed the same of my own free will. I further agree that no oral
representations, statements or inducements apart from the foregoing written agreement have been made.