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ASSUMPTION OF RISK AND RELEASE
The purpose of this notice is to aid you in making an informed decision as to whether you/your child should participate in FILL IN and, as a condition of such participation, sign the foregoing Assumption of Risk and Release. In addition, its purpose is to make you aware that as a participant (or as the parent or guardian of a participant), it is your responsibility to learn about and/or inquire about any concerns that you might have prior to participating and at any time regarding participation safety.
Participating in FILL IN activity is voluntary. As a condition to participate in this activity, you (and your parent(s) or guardian(s) if participant is under 18yrs of age) must agree to assume the risk of injury or death involved in this activity and agree to release and its employees, directors and officers, volunteers, students and agents from liability for ordinary negligence in the conduct of this activity.
Minor participant:
I, _____________________________, as a minor participant and the parent/guardian of _____________________ understand that participating in FILL IN does involve the risk of injury or death. I also understand that by participating in FILL IN, I am subjecting myself to the possibility of injury or death.
Adult participant:
I, _____________________________, understand that participating in FILL IN does involve the risk of injury or death. I also understand that by participating in FILL IN, I am subjecting myself to the possibility of injury or death.
In consideration of permitting ____________________ participation in FILL IN, I/we hereby agree to assume all of the risk of injury or death associated with FILL IN activity; we further agree to release and its employees, directors and officers, volunteers, students and agents from any liability resulting from any ordinary negligence that may arise in connection with this activity. I/we agree that the terms hereof shall serve as an assumption of risks and a release for all members of our family, for heirs, estate, executor, administrator, assignees, indemnitors, subrogees, or other releasees; and we further agree that if any part of this assumption of risk is held void, the remainder shall continue in full force and effect.
CAUTION
By signing this assumption of risk and release, I/we acknowledge that I/we have read its contents and understand its contents and warnings, and that I/we agree to its terms.
_____________________ _______________________
Date Participant Signature
_____________________ _______________________
Date Parent/Guardian Signature (if minor)
_____________________ _______________________
Date Witness
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