I, the undersigned, understand that Heartspring educates students who have significant mental and/or physical disabilities that may result in severe behaviors including but not limited to hitting, biting, kicking, slapping, pulling of hair, and other injurious activities to themselves and/or to others. I understand that being in the student’s environments may expose me to such injurious activities.

I, the undersigned, do hereby for myself, and all who may hereafter claim through or for me, waive and release Heartspring from all claims, rights and causes of action accruing in my favor as a result of personal injury, loss of life, or loss of property against Heartspring and their representatives while completing observations, intern and/or practicum hours at Heartspring. I understand the risk associated with the activity described above, and I agree to participate in that activity. I further agree that no suit or action at law shall be instituted for the above reasons by others or for me on my behalf.

I hereby agree and consent to allow Heartspring to photograph or videotape the below-named person for advertising and publicity purposes by Heartspring, and I waive all claims for any compensation for such use or for damages.