Release Of Liability And Assumption Of Risk Agreement (Minor) (Page 2 of 4) in pdf

___________________________________________________________________________________________________________________________

Emergency Contact #1

Emergency Phone Number #1

Emergency Contact #2

Emergency Phone Number #2

PARENTS SIGNATURE:___________________________________________________________________________________Date_______________

(IF PARTICIPANT IS UNDER 18)

Roseville Police Activities League

…

RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

(MINOR)

I, the parent/guardian of __________________________________________, agree to allow my child to

participate in the activity listed in my child’s registration form including associated travel.

I AM AWARE THIS ACTIVITY IS INHERENTLY DANGEROUS AND AM VOLUNTARILY

ALLOWING MY CHILD TO PARTICIPATE IN THE ACTIVITY WITH KNOWLEDGE OF THE RISKS

INVOLVED, BOTH EXPECTED AND UNEXPECTED, AND HEREBY AGREE TO ACCEPT ANY AND ALL

RISKS OR INJURY OR DEATH.

INITIAL HERE ______

In return for the benefits from my child’s participation, I agree not to sue and release and hold harmless the

County of Placer, Placer SAL, their officers, directors, employees, agents and volunteers from any liability for

any loss, injury, or death connected with my child’s participation in the activity except for loss, injury, or death

caused intentionally or by willful misconduct. The Placer Sheriff’s Activities League reserves the right to

photograph facilities and program participants for promotional purposes. On behalf of my child, I agree to the use

of any such photographs in which he/she may appear. Photographs may be used in brochures, displays with

press releases, on the County of Placer website, any social media website, or the Placer SAL website.

Individuals may submit their photos for consideration.

THIS RELEASE IS INTENDED TO PROTECT THE COUNTY OF PLACER, PLACER SAL, THEIR OFFICERS,

DIRECTORS, EMPLOYEES, AGENTS, AND VOLUNTEERS FROM CLAIMS OF NEGLIGENCE. HOWEVER,

THIS RELEASE IS NOT INTENDED TO EXEMPT THEM FROM RESPONSIBILITY FOR WILLFUL OR

INTENTIONAL ACTS OR OMISSIONS WHICH RESULT IN LOSS, INJURY, OR DEATH.

I HAVE CAREFULLY READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT.

I FULLY UNDERSTAND ITS CONTENTS AND IMPLICATIONS. I AM AWARE THAT THIS IS A

RELEASE OF LIABILITY, HOLD HARMLESS AGREEMENT AND ASSUMPTION OF RISK AGREEMENT

AND THAT IT IS A LEAGALLY BINDING CONTRACT BETWEEN THE COUNTY OF PLACER, PLACER SAL,

MYSELF, AND MY CHILD. I FURTHER UNDERSTAND THAT THIS RELEASE IS BINDING ON MY HEIRS,

PERSONAL REPRESENTATIVES, NEXT OF KIN, SPOUSE, DOMESTIC PARTNER AND ASSIGNS. I SIGN

THIS AGREEMENT OF MY OWN FREE WILL.

TO BE COMPLETED BY PARENT OR GUARDIAN OF MINOR PARTICIPANTS

I have fully read this Agreement and fully understand its content. Furthermore, the significance of this release of liability and

assumption of risk agreement had been EXPLAINED TO THE MINOR.

Signature of parent or guardian:___________________________________________

Date:__________________

Print parent/guardian name: _____________________________________________________________________

Address:_____________________________________________________________________________________

Release Of Liability And Assumption Of Risk Agreement (Minor) Page 2