Click for printable pdf camp r&r waiver
Camp R & R
ACTIVITY/EVENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND
INDEMNITY AGREEMENT (“AGREEMENT”)
I understand the nature of this Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the Activity and inform coordinator. I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which this event takes place, or the negligence of the “releases” named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for loses, cost, and damages I incur as a result of my participation in the Activity.
By completing this form I hereby apply to Ray & Dortha Marty and Tim & Felicia Eyre (thereinafter “Camp R&R”) to participate in the event indicated. By my signature below, I certify that I have read, understood and accept the following stipulations and waiver.
I further understand that Camp R&R and other property owners or lessees will not accept financial or legal liability for any injury or occurrence arising from the listed event and that accordingly, my participation in such activity’s must be at my own risk.
I hereby unconditionally release, acquit, and forever discharge for myself, my personal representatives, heirs, next of kin, and assigns, all claims which I might have against Camp R&R and other property owners or lessees, and any of them in combinations, and their officers, directors, agents, employees or contractors for injury, accident, illness, property damage, death or other occurrences arising in any manner whatsoever out of my participation in these activity’s. I expressly assume all risks of my participation, including the risk that I might be injured as a result of the negligence or gross negligence of Camp R&R and other property owners or lessees, and any of them in combinations, and their officers, directors, agents, employees or contractors.
I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force effect.
I expressly assume financial and/or legal liability for all risks and injury to persons who accompany me on this event including family members, guests, friends and acquaintances, and all other persons who accompany me. Furthermore, I agree to indemnify, save and hold harmless Camp R&R from any and all loses, costs, damages, expenses and attorney’s fees arising out of my participations or the participation of persons who accompany me to the listed event.
Printed name of participant ________________________________________
Today’s Date ___________________________________________________
Signature of Participant ___________________________________________
Date of Birth __________________________________________________
E-mail Address _________________________________________________
Emergency Contact ______________________________________________
Call Sign ___________________________________________________
PARENTAL CONSENT
AND I, the minor’s parent and/or legal guardian, understand that the nature of the above referenced activities and the Minor’s experience and capabilities and believe that the minor is qualified to participate in such activity. I hereby Release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releases from all liability, claims, demands, losses or damages on the minor’s account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost that any Releasee may incur as a result of any such claim.
Printed name of Parent/Legal Guardian __________________________________
Date ______________________________________________________________
Signature of Parent/Legal Guardian______________________________________
E-mail Address _____________________________________________________
Phone_____________________________________________________________
Address___________________________________________________________
City, State, Zip_____________________________________________________
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