Ymca Summer Day Camp Form - 2016 (Page 9 of 9) in pdf

TRANSPORTATION RELEASE

Parent or guardian: This form must be completed entirely as a necessary prerequisite for participation in transportation

services. The YMCA of Greater Omaha (referred to as the “Association”) is funded by public support and operated by the YMCA.

The participant listed is participating in a YMCA program operated by the Association. The participant listed is requesting

transportation to and from programs. Transportation may be provided by a private provider, a YMCA owned and operated

vehicle and/or public transportation systems in the area. I (we) the undersigned understand and authorize the YMCA to trans-

port my child to and from activities offered by the Association. The signing of this permission slip releases and indemnifies the

YMCA Association and it’s agents and/or employees from all liabilities, damages and any claims made by the child or on behalf

of the child, including medical expenses incurred, should serious injury, loss of property, damages or death occur as a result of

his/her participation in the transportation program. We fully understand the nature of the transportation services and the risk

of serious injury, loss of property, damages or death associated with these services.

THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA Association, its

directors, officers, employees, and agents (hereinafter referred to as “releases”) from all liability to the undersigned, his

personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on

account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of

the releases or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein,

or participating in any program affiliated with the YMCA, without respect to location.

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 in, upon, or about the YMCA

Association premises or in any way observing or using any facilities or equipment of the Association or participating in

any program affiliated with the Association whether caused by the negligence of the releases or otherwise.

THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY

DAMAGE due to negligence of releases or otherwise while in, about, or upon the premises of the YMCA Association and/

or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the

Association.

THE UNDERSIGNED further expressly agrees that the forgoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is

intended to be as broad and inclusive as is permitted by the law of the State 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 THIS RELEASE (Parent and/or Guardian)

_______________________________________________________________________________ Printed name of participant

(First, Middle, Last, Suffix (Jr./Sr./II/III)

_______________________________________________________________________________ Signature of parent or guardian

_______________________________________________________________________________ Date of signature

_______________________________________________________________________________ Other names used by parent or guardian

(Maiden/Previous Married/Alias/Nicknames)

YMCA OF GREATER OMAHA . . Page 9

Ymca Summer Day Camp Form - 2016 Page 9