RELEASE OF LIABILITY AND ASSUMPTION OR RISK AGREEMENT
(Read Carefully Before Signing)
RISK OF SERIOUS INJURY. I understand that the risk of injury from participation in this program is significant including the potential for permanent disability, paralysis and death, and while particular rules, equipment, staff attention and personal discipline may reduce this risk, the risk of serious injury does exist. I KNOWINGLY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF RELEASES (AS DEFINED IN #3) OR OTHERS, and assume full responsibility for my participation.
CONDUCT. I hereby acknowledge and agree to abide by the programís rules of conduct and other terms and conditions for my participation in this program. Further, I agree to be responsible for any conduct violation by its affect and me.
RELEASE. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby RELEASE AND INDEMNIFY AND HOLD HARMLESS LOCUST GROVE, its employees, owner and agents, the owners or lessors of other premises used, and other participants (collectively,"the Releases"), WITH RESPECT TO ALL CLAIMS, COST AND CAUSES OF ACTION (INCLUDING ATTORNEYSí FEES) ARISING OUT OF OR IN CONNECTION WITH ANY INJURY, DISABILITY, DEATH, AND/OR LOSS OR DAMAGE TO PERSONS OR PROPERTY, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, IN CONNECTION WITH THE PROGRAM.
PROMOTIONS. I hereby authorize Locust Grove to utilize my photographic or video likeness in the promotion of its programs.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT. I FULLY UNDERSTAND ITS TERMS, I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Participantís Signature ________________________________________________________
Participantís Printed Name ____________________________ Phone __________________
In case of emergency, please notify: ______________________Phone__________________
email address __________________________________________
FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (under 18)
This is to certify that I, as the parent or guardian with legal responsibility for this participant, do consent and agree to all terms and conditions of this Release of Liability and Assumption of Risk Agreement on behalf of said participants.
Printed Name(s) and Age(s) of Minor(s) ___________________________________________
Parent or Guardianís Signature _____________________________________Date__________
Print Name and Address of Parent or Guardian_______________________________________