Ymca Loudoun County Form (Page 3 of 4) in pdf

YMCA OF METROPOLITAN WASHINGTON (“YMCA”) PARTICIPANT WAIVER FORM

ACKNOWLEDGEMENT

I expressly acknowledge that there are certain dangers, risks, illnesses and personal injuries inherent in participating in YMCA’s

programs, events, classes, and/or other activities, which may result from unavoidable accidents or injuries, athletic activities, sports

programs/classes, the use of any equipment, exercise, or other activities or from my or my minor child(ren)’s or ward(s)’s physical

condition. I understand that the YMCA and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns

assume no responsibility for loss, damage, illness or injury to person or property that I or my minor child(ren) or ward(s), if applicable,

may sustain as a result of my or their physical condition or resulting from my or their participation in any activities , programs, events,

classes, the use or non-use of any equipment exercise, horseback riding, archery, field trips, waterfront and pool activities, classes,

events, or programs at and/or sponsored by the YMCA. I expressly acknowledge, on behalf of myself and my minor child(ren) or ward(s),

heirs and executors, that I voluntarily assume the sole risk for any and all dangers, illnesses and personal injuries that may result from

my or my minor child(ren)’s or ward(s)’ participation in any events/activities/programs/classes while at the YMCA and/or sponsored by

the YMCA.

I also acknowledge that the YMCA uses photographs, videotapes, television programs, motion pictures, tape recordings, or

other similar media for promotional purposes. I hereby consent to the use of my and/or my minor child(ren)’s or ward(s)s’ name(s)

and/or likeness(es) in such materials to be exhibited and used for advertising, trade purposes, solicitation of patronage, promotional

purposes, or other similar purposes, even if my and/or my minor child(ren)’s or ward(s)’s name(s) and/or likeness(es) are an integral part

of such photograph, videotape, television program, motion picture, tape recording, or other similar media.

RELEASE

In consideration of the YCMA allowing me/and or my minor child(ren) or ward(s) to attend and/or participate in any programs,

events, classes, or other activities at the YMCA and/or sponsored by the YMCA, I hereby, for myself, my minor child(ren) or ward(s)

heirs, and executors, waive, release and forever discharge the YMCA and its employees, agents, counselors, teachers, trainers,

representatives, successors and assigns, from and against any and all rights and claims for any loss, damage, illness or injuries to person

or property sustained as a result of my attendance and/or participation in any such programs, events, classes, and other activities,

whether or not such loss, damage or injury results from the negligence of the YMCA and its employees, agents, or representatives or

from some other cause. My agreement to release the YMCA does not include any loss, damage, or injury that results from the YMCA’s

gross negligence or willful, wanton, or reckless misconduct.

I further waive any and all rights to inspect or approve the photograph, videotape, television program, motion picture, tape

recording or other use of my and/or my minor child(ren)’s or ward(s)s’ name(s) and/or likeness(es), including any written article, script,

caption or other writing that may accompany such use of my and/or my minor child(ren)’s or ward(s)’s name(s) and/or likenes(es). I

hereby, for myself, my minor child(ren) or ward(s), heirs, and executors, waive, release and forever discharge the YMCA and its

employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all liability, claims,

losses, costs, expenses or damages for libel, slander, invasion of privacy, conversion, defamation, appropriation of likeness or any other

claim based on the use of my and/or my minor child(ren)’s or ward(s)s’ name(s) and/or likeness(es) in any such materials.

INDEMNIFICATION

I hereby represent and warrant to the YMCA that I have the authority to execute this Participant Waiver form on behalf of

myself and/or on behalf of my minor child(ren) or ward(s) as parent, guardian and/or next friend, if applicable. In the event of any

misrepresentation or breach of the foregoing warranty by me, or in the event that I, my minor child(ren) or ward(s), or any other person

nevertheless asserts any claim against the YMCA arising out of my or my minor child(ren)’s or ward(s)’ participation in any program,

event, class or other activity as set forth herein, I agree to indemnify, hold harmless and defend the YMCA from and against any and all

liability, claims, losses, costs, expenses or damages resulting therefrom, including, but not limited to, claims of loss, damage, illness or

injury to person or property whether or not such loss, damage, illness or injury results from the negligence of the YMCA or from some

other cause.

ACCEPTANCE

I expressly acknowledge and agree to the terms and conditions set forth on this Participant Waiver Form.

__________________________________________________

Signature of Participant or Parent/Guardian Date

__________________________________________________

Name(s) and Age(s) or Participants(s)

Ymca Loudoun County Form Page 3

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