Participant Waiver And Hold Harmless Form (Page 2 of 3) in pdf

Participant Waiver And Hold Harmless Form Page 2

5. In signing this Covenant Not to Sue and Agreement to Hold Harmless, I acknowledge and

represent that I have read the foregoing Covenant Not to Sue and Agreement to Hold Harmless, understand it

and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements apart

from the foregoing agreement that has been reduced to writing have been made. I execute this document for

full, adequate and complete consideration fully intending to be bound by the same, now and in the future.

SIGNED this

day of

, 20____.

Participant Signature: __________________________________________

Printed Name: _________________________________________________

Parent or Legal Guardian Signature: ______________________________

(If Participant is under 18 years old)

Parent or Legal Guardian Printed Name: ______________________________

(If Participant is under 18 years old)

Witness Signature: __________________________________________

Witness Printed Name:________________________________________

INSTRUCTIONS TO SPONSORS

Complete all blanks in form prior to execution.

Provide copy of executed form to Participant.

If a special event or other policy of insurance is in effect for the Activity, delete paragraph 3

and initial.

Attach additional pages as necessary to describe Activity or Inherent Risks, and have

Participant initial all such pages at the time of execution of this document.

Keep this release on file in appropriate office of Sponsor.

OGC Approved 10/25/02

Participant Waiver And Hold Harmless Form Page 2