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

Accident Waiver And Release Of Liability Form Page 2

I hereby consent to receive medical treatment which may be deemed advisable in case of injury,

accident, and/or illness during the Event.

The 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.

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Date

Print Participant's Name

Date of Birth of Participant

_______________________

(____) ____-_________

Name of Emergency Contact

Phone Number of Emergency Contact

PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years old)

As consideration for allowing the minor to participate in the Event, the parent of the minor must sign

and agree to the following. 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 or ward’s participation in the

Event, and has agreed individually to the terms of the accident waiver and release of liability set forth

above, and shall be bound to the terms and conditions. The undersigned parent or guardian further

agrees that he/she will defend, hold harmless and indemnify WMBC, and/or its directors, officers,

employees, volunteers, representatives, and agents, insurers, POLYGON FINANCIAL 05, LLC, Event

holders, Event sponsors, Event volunteers from all suits, liabilities, damages, injuries or claims suffered

by or brought by the Minor, or arising out of any injury or death to the Minor, and/or the above Minor’s

participation in this Event, whether caused by the negligence of a released party or otherwise.

Date ___/___/___

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