Full Text
Otsego County Parks & Recreation Department Student Waiver, Release and Indemnity Agreement (To be filled out and updated on an annual basis by/for the participant) Participant Name: of Birth: Street Address: Male Female City, State, ZIP: Parent/Guardian Name 1: Phone: Parent/Guardian Name 2: Email WAIVER, INDEMNITY, AND RELEASE OF LIABILITY Identification of Risk: I, the undersigned parent or guardian of the above-named participant who is a minor, understands that inherent and other risks involved in sporting, exercise, or other types of recreational sponsored activities could result in injuries or illness to the participant. I understand that these injuries might result not only from my actions but from the actions and inactions of others. Given this awareness, I, the undersigned parent or guardian of the above-named participant who is a minor, nevertheless give my consent and permission for the minor participant to participate in all Otsego County Parks & Recreation Department activities. [initial] Waiver, Release and Indemnity: PLEASE READ CAREFULLY BEFORE SIGNING I understand and hereby agree to assume all of the risk which may be encountered with the participant’s participation in the Otsego County Parks & Recreation Department sponsored activities. To the fullest extent allowed by law, I hereby release and hold harmless the Otsego County Parks & Recreation Department and Otsego County, its officials, agents and employees from any and all responsibility and legal liability for any property or personal injury damages to the participant resulting from any claim arising from the minor’s participation in a Otsego County Parks & Recreation Department activity or sponsored activity and I will indemnify, hold harmless, and defend them if any and all liability, actions, causes of actions, claims, expenses, and damages on account of any property or personal damages or injuries sustained by the participant which may arise out of and in connection with any activity or participation by the participant or minor in Otsego County Parks & Recreation Department activities. [initial (continued on other side) ---PAGE BREAK--- I, on behalf of myself, my personal representatives, heirs, and next of kin, understand, affirm, and agree that I voluntarily waive, release, indemnify, hold harmless, and discharge OTSEGO COUNTY, OTSEGO COUNTY PARKS & RECREATION DEPARTMENT, and their assigns, agents, designates, elected and appointed officials, employees, officers, managers, representatives, and volunteers from any and all liability, claims, demands, actions, rights of actions, or legal proceedings whatsoever, arising from any claims of personal injury, death, or damage to personal property associated with any Otsego County Parks & Recreation Department activity and/or sponsored activity. This release is binding even if said personal injury or property damage is caused by the actions of other participants or spectators, any condition of the land or alterations or additions thereto, and all claims whatsoever arising out of or connected with the activity. I further state that I, the undersigned, have fully read the foregoing release, waiver and indemnity agreement, as well as the identification of risk, and know the contents thereof and sign this document as my own free act and deed. For participants under age 18: I consent to the above person’s participation in the Otsego County Parks & Recreation Department activities. I acknowledge for myself and/or as the parent or guardian with legal responsibility for the minor participant, I verify that I have the authority to enter into this Agreement on behalf of the minor participant. Parent/Guardian signature if participant is a minor Print Name Date: Release to Use Photos I, the parent or guardian for the above-named participant, hereby GRANT DENY [initials: the authority to use any photos taken of the participant in the course of any Otsego County Parks & Recreation Department activity for use in any informational or promotional brochures or other publications of the Otsego County Parks & Recreation Department. Parent/Guardian signature if participant is a minor Print Name Date: