Ymca Spring Basketball Registration Form Page 2

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MEMBER/CHILDREN
RELEASE and WAIVER of LIABILITY and INDEMNITY AGREEMENT
IN CONSIDERATION of being permitted to utilize the facilities, services and programs of the SOUTHEAST
VENTURA COUNTY YMCA (or for my children to so participate) for any purpose, including, but not limited to
observation or use of facilities or equipment, or participation in any off-site program affiliated with the YMCA,
the undersigned, for himself or herself and such participating children and any personal representatives, heirs,
and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or
participating, will inspect and carefully consider such premises and facilities or affiliated program. It is further
warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in
such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment
thereof and such affiliated program have been inspected and carefully considered and that the undersigned finds
and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation
by the undersigned and such children.
IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT
NOT LIMITED TO, OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY OFF-SITE
PROGRAM AFFILIATED WITH THE YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:
1.
THE UNDERSIGNED ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES,
WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE the YMCA and all branches thereof, its directors, officers,
employees and agents (hereinafter referred to as “releases”) from all liability to the undersigned or such children
and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or
demands thereof on account of injury to the person or property or resulting in death of the undersigned or such
children whether caused by the negligence of the releases or otherwise while the undersigned or such children is
in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated
with the YMCA.
2.
THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and
each of them from any, loss, liability, damage or cost they may, incur due to the presence of the undersigned or
such children in, upon or about the YMCA premises or in any way observing or using any facilities or equipment of
the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence of the
releases or otherwise.
3.
THE UNDERSIGNED ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR
PROPERTY DAMAGE to the undersigned or such children due to negligence of releases or otherwise while in,
about or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon
or participating in any program affiliated with the YMCA.
THE UNDERSIGNED further expressly agrees that the foregoing RELEASE WAIVER AND INDEMNITY
AGREEMENT is intended to be as broad and inclusive as permitted by the law of the State of California and that if
any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force
and effect.
THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND
INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from
the foregoing written agreement have been made.
I HAVE READ AND UNDERSTAND THIS DOCUMENT AND RELEASE.
Print Name: __________________________________________ Signature of Applicant/Parent:_________________________________________________
Print Name: __________________________________________ Signature of other Adult/Parent:______________________________________________
Print Name: __________________________________________ Name of Child in Program: _____________________________________________________
Print Name: __________________________________________ Name of Child in Program: ____________________________________________ _________
Print Name: __________________________________________ Name of Child in Program: _____________________________________________________
Print Name: __________________________________________ Name of Child in Program: _____________________________________________________

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