Fillable Printable Release of Liability Form Sample-USAW Adult Waiver (Specific Events)

Release of Liability Form Sample-USAW Adult Waiver (Specific Events)

PARTICIPANT WAI VER AND RELEAS E OF LIABILITY,

ASSUMPTION OF RISK AND INDE MNI T Y AGREEMENT

SampleWaiv er Form for MINORS(Under Age 18)

Event Name/Activity Description: __________________________________________________________________________________

Event/Activity Date(s): _______________________________________________________________________________________________

Event/Activity Location: _________________________________________________________________________________________

For and in cons ideration of [Insert Name of Instructor/Coach](“Coach”)allowing the minor identified below (“Minor”)to participate in the event

or activity described abov e(the “Event” or “Events”); I, for myself, and on behalf of Minor, and the Minor’s parents/legal guardians, heirs and

next of kin, and any legal and personal representatives, executors, administrators, successors and assigns, hereby agree to and make the

following contractual representations pursuant to this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement (the

“Agreement”);

1.I hereby represent that (i) I am the parent or legal guardian of the Minor; (ii) the Min or is in good health and in proper p hysical con dition to

participat e in the E v ent ; and ( iii) the M inor is not under t he inf luence of alc ohol or any illic it or pres cript ion drugs which w ould in any w ay

impair the Minor’s ability to safely participate in the Event, and that I am responsi ble for the Minor’ s safety and well being at a ll times and

under all circumstances while at the Event.

2.I underst and and ac k now ledge t he risks and danger s as s ociated with the M inor ’s par tic ipa tion in t he Event and the sport of water s kiing

and related water sport disciplines, including without limitation, the potential for serious bodily injury, sickness and disease, permanent

disability , paralysis and los s of life; loss of or damage to equipment /property; exp osure to extrem e conditions and ci rcumstanc es; contact

with other participants, spectators, boats, animals or other natural or manmade objects; dangers arising from adverse weathe r conditi ons;

imperfec t sk i cour s e condition s ; w ater and s ur fac e hazards ; equipm e nt fai lure; inadequat e s afe ty m eas ur es ; pa rti c ipant s of v a r y ing s k ill

levels; situations beyond the immediate control of the Event Organizers; and other undefined, not readily foreseeable and presently

unknown risks and dangers (“Risks”). I understand that these Risks may be caused in whole or in part by the Minor’s own actions or

inactions , t he ac tion s or in ac tions of others participating in the Ev ent, or th e negligent ac ts or om iss ions of the Releas ed Partie s defined

below, and on behalf of the Minor, I hereby expressly assume all such Risks and responsibility for any damages, liabilities, losses o r

expenses which I incur as a result of the Minor’s participation in any Event.

3.I understan d that the Minor is r equired to be familiar wit h and to abide by t he Rules and Regulations established for the benefit and safety

of all participantsin t he Event. I ac c ept s ole r es pons ibil ity f or th e c onduct and actions of the Minor while he or s he is par ticipat ing in the

Event, and the condition and adequacy of the Minor’s equipment. I understand that the Event Organizers have the right to disqualify

anyone or deny participation in the Event for any reason they deem just and proper in their sole discretion.

4.On behalf of the Minor, I hereby Release, Waive and Covenant Not to Sue, and further agree to Indemnify , Defend and Hold Ha rmless the

following parti es : [ Ins er t N am e of C oac h and o ther part ies to be Released] (Individual ly and Col lectively, the “R eleased Par ties” or

“Event Organizers”), with respect to any liability, claim(s), demand(s), cause(s) of action, damage(s), loss or expense (including court

costs and reasonable attorneys fees) of any kind or nature (“Liability”)which may arise out of, result from, or relate in any way to the

Minor’s participation in the Event, including c laims for Liability c aused in whole or in part by the negli gent act s or omis si ons of the Released

Parties. I further agree that if, despite this Agreement, the M inor, or anyone on the Minor’s behalf, makes a claim for Liability against any of

the Released Parties, I will indemnify, defend and hold harmless each of the Released Parties from any such Liabilities whichany may be

incurred as the result of such claim.

I hereby warrant that I am of legal age and authorized to enter into this Agreement on behalf of the Minor, that I have read this Agreement

carefully , unders tand its term s and c onditions , ack nowledge that I will be giving up substantial leg al rights by signing it (inc luding the rights of

the Minor, the Minor’s parents /legal guardians, heirs and next of k in, an d any legal a nd pers o nal rep res ent ativ e s , ex ec u tor s , administrators,

successors and assigns), acknowledgethat I have signedthis Agreement without any inducement, assurance or guarantee, and intend for my

signature to serve as confirmation of my complete and unconditional acce ptan ce o f th e term s, cond itio ns a nd pro vis ions of this Agreement. This

Agreement represents the complete understanding between the parties regarding these issues and no oral representations, statements or

inducements have been made apart from this Agreement. If any provision of this Agreement is held to be unlawful, void, or for any reason

unenforceable, then that provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any

remaining provisions.

Nameof Minor: _________________________________________Age: ______Date of Birth: ______

/______/_______Male Female

X ____________________________________________________________/_______/____________

Signatureof Parent/Legal Guardian for Minor(s)Date Signed

Revised 1/01/2011