Liability Release Form printable pdf download

JEFF’S S PORTS C ONNECTION -‐ L IABILITY R ELEASE F ORM

Child’s N ame: _ ____________________________ M/F: _ ___

Date o f B irth: _ _________

Name o f P arent o r G uardian: _ __________________________________________________

Address: _ ___________________________________________________________________

Home P hone: _ ____________________

Cell p hone: _ _________________

Business P hone: _ __________________

Alternate: _ __________________

E-‐mail: _ ____________________________________________________________________

Activity: R ecreational B asketball L eague

Organization: J eff’s S ports C onnection a ka J eff’s S ports a nd S pecialties – J effrey R . P owell

LIABILITY R ELEASE

I h ereby d eclare t hat I a m t he p arent o r l egal g uardian o f t he a bove-‐named c hild a nd t hat s aid

minor h as m y e xpressed p ermission t o p articipate i n t he m entioned a ctivities i ncluding b ut n ot

limited t o r unning, j umping, f alling, a nd o ther i nvolvements a ssociated w ith p hysical a ctivity.

Accordingly, f or m yself a nd o n b ehalf o f s aid m inor, I d o h ereby f orever r elease a nd d ischarge

Jeff’s S ports C onnection, J effrey R . P owell, t he C ity o f A naheim, t he A merican S ports C enter, t he

City o f O range, t he S uper S ports C enter, t he T ustin S alvation A rmy, t he C ity o f T ustin, O range

High S chool a nd O range U nified S chool D istrict, a nd a ny i nvolved m unicipalities o r o ther p ublic

entities, t heir e mployees a nd a ll s ponsors, p roducers, a gents, r epresentatives, s uccessors, a nd

assigns o f a ll l iabilities, c laims, a ctions, d amages, c osts, o r e xpenses w hich s aid m inor o r I m ay

have a gainst a ny o r a ll o f t hem a rising o ut o f o r i n a ny w ay c onnected w ith p articipation i n t he

above m entioned a ctivity. I u nderstand t hat t his r elease i ncludes a ny c laims b ased o n

negligence, a ction o r i naction o f a ny o f t he a bove-‐named p arties.

I f urther u nderstand t hat s erious a ccidents m ay o ccur d uring s aid a ctivity a nd t hat p articipants

in s uch a ctivity o ccasionally s ustain m ortal o r s erious p ersonal i njuries, a nd/or p roperty

damage, a s a c onsequence t hereof. K nowing t he r isks o f s aid a ctivity, n evertheless, o n b ehalf

of s aid m inor c hild, I h ereby a gree t o v oluntarily a ssume t hose r isks a nd t o r elease a nd h old

harmless a ll o f t he p ersons o r e ntities m entioned a bove w ho, t hrough n egligence o r

carelessness, m ight o therwise b e l iable t o m e, s aid m inor, o r t he h eirs a nd a ssigns o f m yself a nd

said m inor, f or d amages.

It i s f urther u nderstood a nd a greed t hat t his w aiver, r elease a nd a ssumption o f t he r isk i s t o b e

binding o n t he h eirs a nd a ssigns o f m yself a nd s aid m inor.

Liability Release Form