Villa Roma Waiver Form printable pdf download

MONMOUTH COUNCIL BSA

VILLA ROMA WAIVER

Horseback Riding

(INDIVIDUAL)

Climbing Wall

(INDIVIDUAL)

Inflatables

(INDIVIDUAL)

Paint Ball

(INDIVUDAL)

GO-Karts

(INDIVIDUAL)

Participant Name

DATE

(Print)

In consideration of being allowed to participate in any way at Villa Roma Resort and related events and activities I

the undersigned, acknowledge, appreciate, and agree to the following:

1) The risk of injury from the activities involved in Horseback Riding/Climbing Wall/Inflatables/Paintball &

Go-Karts is significant, including the potential for permanent paralysis and death.

2) I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence

of Villa Roma Resort or others, and Assume full responsibility for my participation. I confirm that I am

physically and mentally capable of participating in Potato Sack Slide Riding/Wall Climbing/Inflatables.

3) I for myself and on behalf of my heirs, assigns ,personal representatives and next of kin, hereby release,

indemnify, and hold harmless Villa Roma Resort, its officers, officials, agents, and/or employees, other

participants, sponsors, advertisers and if applicable, owners and lessors of premises used for Potato Sack

Slide Riding/Climbing Wall/Inflatables (RELEASEES), FROM ANY AND ALL CLAIMS, DEMANDS,

LOSSES, AND LIBABIUTY ARISING OUT OF OR RELATED TO ANY INJURY, DISABILITY, OR

DEATH I MAY SUFFER, or loss or damage to person or property. Whether arising from the negligence of

the releasees if otherwise to the fullest extent permitted by law.

4) I permit the use of any photos, slides, film, or sketches of me taken during the day's activity for publicity,

advertising, promotions, or other commercial purposes.

5) In consideration of using the facility PARTICIPANT CONTRACTUALLY AGREES that ALL claims for

injury and/or death Shall be GOVERNED BY NEW YORK STATE LAW AND EXCLUSIVE

JURISDICT1ON shall be in the District court resident where the allege incident occurred. (Sullivan County,

NY)

6) PARTICIPANTS GOING ON THE GO-KARTS MUST BE AT LEAST 56 INCHES IN HEIGHT AND

AGE 10 AND UP FOR SINGLE RIDERS ONLY. MUST BE 18 YEARS OF AGE FOR DOUBLES.

7) PARTICIPANTS GOING HORSEBACK RIDING & PAINT BALL MUST BE 10 YEARS OF AGE OR

OLDER.

I have read this release of liability and assumption of risk agreement, fully understand its terms,

understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without

any inducement.

Signature _________________________________________ Date _________________ Age ________

Street ______________________________ City ____________________ State ______ Zip _________

FOR PARENT/GUARDIANS OF PARTICIPANTS OF MINOR AGE: This is to certify that I, as

parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as

provided above all the Releasees, and for myself, my heirs, assign, and next of kin. I release and agree to

indemnify Villa Roma Resort from any and all liability incidents to my minor child's participation with

these activities as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE

RELEASEES to the fullest extent permitted by law.

Parent/Guardian Signature

Date

Villa Roma Waiver Form

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