Liability Waiver and Hold Harmless Agreement

Innovators’ Workshop

Individuals using the Innovators' Workshop are required to read the following information

carefully and fully understand before participating in any activity or program. You agree that you

are voluntarily participating with the knowledge of the risks in doing so.

I, ________________________________, am fully aware that participation in the

(Print name)

Innovators' Workshop may result in risk of personal injury or harm.

I hereby agree to release and hold harmless the Town of Simsbury, the Simsbury Public Library,

their respective Boards of Directors, agencies, officers, employees, committees, and volunteers,

from and against all liability, loss, damages, claims, or actions (including legal costs and

attorney fees) for any bodily injury and/or property damage, to the extent permissible by law

arising from or related to my participation.

This indemnification and hold harmless agreement shall include indemnity against all costs

(including without limitation, reasonable attorney's fees and court costs), expenses and liabilities

incurred or in connection with any such claim or proceeding brought thereon and in defense

thereof.

In signing this release, indemnification and hold harmless form, I acknowledge that I have read

and understand fully the foregoing agreement, and sign it voluntarily as my own free act and

deed; no oral representations, statements, or inducements, apart from the foregoing written

agreement, have been made. I hereby give permission to the Simsbury Public Library for

emergency transportation and/or treatment in the event of illness or injury. I hereby accept

responsibility for the payment of any emergency transportation and/or treatment. I further certify

that I am fully competent and in good physical condition, and have no medical or physical

conditions that would restrict my participation in any program or activity.

_________________________________________ ___________________

Signature Date

________________________________________________________________________

Address

_____________________________________________ _________________________

email Address Telephone

Revised April 2014.

Fillable Printable Liability Waiver and Hold Harmless Agreement