Release Indemnification & Hold Harmless Agreement Template printable pdf download

Release Indemnification & Hold Harmless Agreement

Attendee(s) under the age of 18 must have Parent or Legal Guardian's Signature

Form must be filled out in entirety.

*THIS IS A LEGAL RELEASE*

Date(s) of Program:

Attendee Name(s):

Address:_________________________ City:______________ State:_______ Zip:____________

Email:____________________________ Home Ph:_______________ Cell Ph:_______________

Name(s) and contact information MUST be complete.

NOTIFICATION OF RISK

I understand that certain risks and dangers exist in the programs and activities in which the attending

adult or minor child voluntarily chooses to participate in at Doe River Gorge. These inherent risks

cannot always be foreseen nor eliminated without destroying the unique character of the activities and

include, but are not limited to loss or damage to personal property, accidental injury or illness of any

kind, or in extreme cases, permanent trauma, disability or death. I understand that Doe River Gorge

considers it important for me to know in advance what to expect and to be informed of the inherent

risks involved in the outdoor, high adventure types of activities that are listed but not limited to the

activities listed in the program catalog. The physical activities including running, climbing, and hiking

over rugged terrain conducted day and night may cause slipping or falling. Waterfront activities

conducted in the lake and river carry the risk of drowning. Environmental risks and hazards include

rapidly moving, deep or cold water; insects, snakes, and predators, including large animals; falling and

rolling rock; lightning, flash floods, falling timber, and unpredictable forces of nature, including

weather which may change to extreme conditions without notice. Activities may occur in remote

places, away from medical facilities where communication and transportation are difficult. Equipment

may fail or malfunction, despite reasonable maintenance and use.

I understand that the above description of the risks is not complete and that there may be other

unknown or unanticipated risks. I expressly acknowledge and assume the inherent risks identified

herein and those inherent risks not specifically identified. I acknowledge that participating in the

activities provided by Doe River Gorge is not compulsory, and hereby knowingly and willingly choose to

participate or allow the attending minor child to participate, in spite of and with full knowledge of the

risks involved.

INDEMNIFICATION AND HOLD HARMLESS AGREEMENT

Understanding the inherent risks, I individually and as the parent or legal guardian of the attending

minor child, AGREE TO RELEASE FROM ANY LIABILITY AND TO DEFEND, INDEMNIFY AND HOLD HARMLESS

DOE RIVER GORGE MINISTRIES and its officers, directors, employees, servants, volunteers and agents

(collectively "Doe River Gorge") from any liability, claims, causes of action, demands, costs, obligations

or financial responsibility of every kind and nature, including that resulting from or arising out of

NEGLIGENCE of Doe River Gorge, for any incident, injury or accident occurring to myself, the attending

minor child, or member of my family, while engaging in or observing any activity at Doe River Gorge.

By agreeing to this indemnification, I am knowingly and willingly choosing to be financially responsible

for any future claims brought against Doe River Gorge.

I acknowledge that I am voluntarily electing to allow my minor to participate in such activities for their

benefit. Knowing of the risks, I hereby EXPRESSLY AGREE to HOLD HARMLESS and INDEMNIFY Doe River

Gorge for any claims that may be brought by my minor child or family members.

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SIGNATURE REQUIRED ON BACK

Rev’d 1-20-15

Release Indemnification & Hold Harmless Agreement Template

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