Accident Waiver And Release Of Liability Form (Page 2 of 2) in pdf

Rocky Mountain Section of the American Water Works Association

& Rocky Mountain Water Environment Association

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

Name of the Activity or Event: ________________________________________________________________

Date of Activity or Event: _______________________________________

IN CONSIDERATION FOR permission granted me by The Rocky Mountain Section of the American Water Works Association

(RMSAWWA) and/or the Rocky Mountain Water Environment Association (RMWEA) to participate in this activity or event, I agree

to the following terms for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS

ACTIVITY OR EVENT, I acknowledge that this activity or event may involve a test of a person’s physical and mental limits and may

carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by

terrain, facilities, temperature, weather, condition of participants, lack of hydration, equipment, vehicular traffic, actions of other

people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers

of the event. These risks are not only inherent to participants, but are also present for volunteers.

I RELEASE, HOLD HARMLESS AND PROMISE NOT TO SUE, the RMSAWWA and RMWEA, including their directors, officers,

employees, volunteers, representatives, and agents, and the activity or event holders, sponsors and volunteers, from all damages,

claims and causes of action arising from the negligence or fault of the entities or persons released, for my death, disability, personal

injury, property damage, property theft, or any other damages, claims and causes or action arising out of my participation in the

activity or event , including but not limited to my traveling to and from the activity or event AND PROMISE NOT TO SUE THE

DESCRIBED RELEASEES regarding the matters described in this paragraph.

I hereby consent to receive appropriate medical treatment in the event of injury, accident, and/or illness during this activity or event.

Any costs incurred for such treatment will be my sole responsibility and I will not seek reimbursement from RMSAWWA, RMWEA

or any of their directors, officers, employees, volunteers, representatives and agents, the activity or event holders, sponsors, or

volunteers.

I understand I may be photographed at this event or activity. I agree to allow my photo, video, or film likeness to be used for any

legitimate purpose by the event holders, producers, sponsors, organizers, and their assigns.

This Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent

permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM

AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

________________________________

_______________________________

__________

Print Participant’s Name

Signature

Date

Address:__________________________________________________________________________________________

Phone: ___________________________________________________________________________________________

Emergency Contact: ________________________________________Phone:___________________________________

PARENT / GUARDIAN WAIVER FOR MINORS (if under 18 years old, parent or guardian must also sign)

The undersigned parent and natural guardian does hereby represent that he/she is in fact acting in such capacity, has consented to

his/her child’s or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward to the

terms of the Accident Waiver and Release of Liability set forth above. On behalf of the child or ward, the undersigned parent or

guardian further agrees not to sue and to save and hold harmless and indemnify each and all of the parties referred to above according

to the terms and conditions set forth above.

________________________________

_______________________________

__________

Print Participant’s Name

Signature of Parent or Guardian

Date

Accident Waiver And Release Of Liability Form Page 2

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