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Parent/Guardian Permission Slip

Tyler's House KC is currently serving high school students only. 


The individual named below (referred to as “I” or “me”) is the parent or legal guardian of the child named below who will be participating in after-school activities and other events (the “Activity”) hosted or sponsored by at Tyler’s House KC, Inc., a Kansas not for profit corporation (the “Tyler’s House”) operating at various locations throughout the Kansas City metropolitan area (the “Premises”). In consideration of being permitted by Tyler’s House to be on the Premises and engage in the Activity and in recognition of Tyler’s House’s reliance hereon, I agree to all the terms and conditions set forth in this agreement (this “Release”).

1 PERMISSION. I give my permission for my child listed below to take part in activities and to  attend events hosted or sponsored by Tyler’s House during 2021/2022.

2 EMERGENCY MEDICAL AUTHORIZATION. In case of a medical emergency occurring while my child is attending any Tyler’s House Activities, I give authorization for emergency medical treatment for the child I have listed below. I understand that my authorization for medical treatment will be in effect each time my child attends each Activity. I also understand that Tyler’s House is not liable for costs related to any medical emergencies that occur while my child is participating with Tyler’s House.

3 COVID-19; ASSUMPTION OF RISK. I am aware of the highly contagious nature of bacterial and viral diseases including the 2019 novel coronavirus disease (COVID-19) (collectively, the “Disease”) and the risk that my child may be exposed to or contract the Disease or other infectious diseases by being on the Premises and engaging in the Activity. I understand and acknowledge that such exposure or infection may result in serious illness, personal injury, permanent disability, death, or property damage. I acknowledge that this risk may result from or be compounded by the actions, omissions, or negligence of others, including Tyler’s House employees or volunteers. I understand that while Tyler’s House has implemented preventative measures designed to reduce the spread of the Disease (including wearing face masks/coverings; frequent sanitization of surfaces; etc.), Tyler’s House cannot guarantee that my child will not become infected with the Disease or other infectious diseases while on the Premises and that being on the Premises may increase my child’s risk of contracting the Disease. NOTWITHSTANDING THE RISKS ASSOCIATED WITH THE DISEASE, I ACKNOWLEDGE THAT MY CHILD IS VOLUNTARILY ENTERING THE PREMISES TO ENGAGE IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGER INVOLVED. I HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF PERSONAL INJURY, ILLNESS, DISABILITY, DEATH, OR PROPERTY DAMAGE RELATED TO THE DISEASE, ARISING FROM MY CHILD BEING ON THE PREMISES OR ENGAGING IN THE ACTIVITY, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE TYLER’S HOUSE OR OTHERWISE.

4 WAIVER AND RELEASE. I hereby expressly waive and release any and all claims, now known or hereafter known, against Tyler’s House, and its officers, directors, managers, employees, agents,affiliates, members, successors, and assigns (collectively, “Releasees”), on account of injury, illness, disability, death, or property damage arising out of or attributable to my child being on the Premises or engaging in the Activity and being exposed to or contracting the Disease, whether arising out of the ordinary negligence of Tyler’s House or any Releasees or otherwise. I covenant not to make or bring any such claim against Tyler’s House or any other Releasee, and forever release and discharge Tyler’s House and all other Releasees from liability under such claims. This waiver and release does not extend to claims for gross negligence, willful misconduct, or any other liabilities that Kansas law does not permit to be released by agreement. I understand that by signing this release, I am waiving any and all claims of any kind arising out of or attributable to my child being on the Premises or engaging in the Activity and being exposed to or contracting the Disease, including those claims that may be unknown to me, or which I do not suspect to exist at this time.

5 PHOTO RELEASE. I give full permission for my child’s image and voice to be used in publicity photos, films, and video. (No last names or personal info will be used). The undersigned releases and forever discharges Tyler’s House and its directors, agents, officers, and employees and volunteers from any and all claims and demands arising out of or in connection with the publication or any other use of said photos/videos/images, including but not limited to, any claims for invasion of privacy or defamation. 

6 COVID-19 GUIDELINES. I am familiar with federal, state, and local laws, orders, directives, and guidelines related to the Disease, including the Centers for Disease Control and Prevention (CDC) guidance on the Disease. My child will comply with all such orders, directives, and guidelines while on the Premises, including, without limitation, requirements related to hand sanitation, social distancing, and use of face coverings when feasible. My child will also follow all instructions of Tyler’s House while on the Premises. I agree to not allow my child to enter the Premises if he/she is experiencing symptoms of the Disease (such as cough, shortness of breath, or fever), has a confirmed or suspected case of the Disease, or has come in contact in the last 14 days with a person who has been confirmed to have or suspected of having the Disease.

7 INDEMNIFICATION. I shall defend, indemnify, and hold harmless Tyler’s House and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney fees, fees, the costs of enforcing any right to indemnification under this Release, and the cost of pursuing any insurance providers, incurred by Tyler’s House or any other Releasees arising out or resulting from any claim of a third party related to the Disease due to my child engaging in the Activity or being on the Premises, including any claim related to my child’s own negligence or the ordinary negligence of Tyler’s House.

8 MISCELLANEOUS. This Release constitutes the sole and entire agreement of Tyler’s House and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction. This Release is binding on and shall inure to the benefit of Tyler’s House and me and our respective successors and assigns. All matters arising out of or relating to this Release shall be governed by and construed in accordance with the internal laws of the State of Kansas without giving effect to any choice or conflict of law provision or rule (whether of the State of Kansas or any other jurisdiction). Any claim or cause of action arising under this Release may be brought only in the federal and state courtslocated in Johnson County, Kansas and I hereby consent to the exclusive jurisdiction of such courts.

9 CHILD’S INFORMATION. I am the parent or legal guardian of the minor named below. I have the legal right to consent to and, by signing below, I hereby consent in all respects to the terms of this Release.



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