Guest Pass Form (Page 2 of 2) in pdf

YMCA OF GREATER GRAND RAPIDS

GUEST RELEASE, INDEMNITY, AND ASSUMPTION OF RISK

IN CONSIDERATION of [me/my minor child (circle one)] being permitted to utilize the facilities, equipment, services and programs

of the YMCA of Greater Grand Rapids (“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, I for myself and on behalf of my personal

representatives, heirs, assigns and next of kin:

1. Acknowledge, agree and represent that I have or, immediately upon [my/my minor child’s (circle one)] entrance into or

participation with the YMCA, will inspect and carefully consider such premises and facilities or the 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 thereon 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.

2. Assume the risk of participating in and the utilization of the facilities, services, equipment and programs of the YMCA and/

or any off-site program affiliated with the YMCA, and I agree to expressly and voluntarily assume all costs, risks and full

responsibility for any bodily injury, death or property damages arising out of or related to such use and/or participation.

3. Release, waive, discharge my right (and my minor child’s right) and covenant not to sue and further agree to indemnify and hold

harmless the YMCA and/or its affiliates, board members, donors, officers, employees, volunteers, trustees and agents of the

foregoing entities, in their individual and representative capacities, from any and all liability, claims, costs, expenses, attorney

fees, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death,

that may be sustained by me, my minor child, or my/our heirs, or any property belonging to me (or my minor child), as a result

of the participation in or the utilization of the facilities, services, equipment and programs of the YMCA and/ or any off-site

program affiliated with the YMCA.

4. Give permission to the YMCA and its affiliates to use, without limitation or obligation, photographs, film footage, tape

recordings or other media that may include the undersigned’s image or voice for purposes of promoting or interpreting the

YMCA.

5. Expressly agree that this RELEASE, INDEMNITY AND ASSUMPTION OF RISK AGREEMENT (“Agreement”) is intended to be as

broad and inclusive as permitted by the laws of the State of Michigan and shall be governed by and interpreted in accordance

with the laws of the State of Michigan. In the event that one or more of the clauses of this Agreement is found to be

unreasonable, unenforceable, illegal, or overbroad by a court of competent jurisdiction, I agree that the Agreement will remain in

full force and effect except for the unreasonable, unenforceable, illegal or overbroad provision(s), and wherever it is reasonably

possible to do so, the unreasonable, unenforceable, illegal or overbroad provision(s) may be modified by a court of competent

jurisdiction in an attempt to give such provision(s) the maximum effectiveness intended as originally drafted.

FOR MINOR GUESTS ONLY

I certify that I am the parent and/or legal guardian of _________________________________________________________________________ (the minor)

who is currently under the age of 18.

I certify that I am at least 18 years of age and I have read, understand, and voluntarily accept the terms of this Agreement

and further agree that no oral representations, statements or inducement apart from the foregoing Agreement have been

made.

Signature of guest/ participant

Date

YMCA OF GREATER GRAND RAPIDS | 475 Lake Michigan Drive NW, Grand Rapids, MI 49504 | 616.855.9622 |

Guest Pass Form Page 2