Release from Liability and Indemnification
Effective 1/1/2012-12/31/2012
Physical Fitness Classes
I, __________________________, hereby agree to the following:
Please print your full name
I understand that it is my responsibility to consult with a physician prior to and regarding my
participation in the Physical Fitness Classes. I represent and warrant that I am physically fit and I
have no medical condition that would prevent my full participation in Physical Fitness Classes.
In consideration of being permitted to participate in the above stated recreation activity(ies), I
hereby waive, release, and discharge any and all claims for damages for personal injury or
property damage or losses, expenses, including reasonable attorney fees, which I may have or
which may hereafter accrue to me, against the COUNTY OF MENDOCINO as a result of my
participation in the activity(ies). The release is intended to discharge the COUNTY OF
MENDOCINO, its officers, officials, employees, instructors, agents, and volunteers, from any and
all liability arising out of or connected in any way with my participation in the activity(ies) even
though that liability may arise out of the negligence or carelessness on the part of other persons.
I further understand that accidents and injuries can arise out of the activity(ies), knowing the
risks, nevertheless, I hereby agree to assume those risks and to release and to hold harmless the
COUNTY OF MENDOCINO and all of the persons mentioned above who might otherwise be liable
to me or my heirs or assigns for damages. It is further understood and agreed that this waiver,
release and assumption of risks is to be binding on my heirs and assigns.
I have read the above Release from Liability and Indemnification agreement and fully understand
its contents. I voluntarily agree to the terms and conditions stated above. I also acknowledge
that individuals under the age of 18 are not permitted to participate in MCWOW Physical Fitness
Classes.
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I am a County Employee
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I am a dependent of a County Employee. The employee’s name is _____________________
____________________________________
______________________
SIGNATURE OF PARTICIPANT
DATE
9/16/10 Approved by County Counsel
S:Forms & TemplatesBenefitsMCWOWCLASS FORMSWaiversPhysical Activity Liability Release 2012.doc