NOTE: THIS FORM MUST BE READ AND SIGNED BEFORE THE PARTICIPANT IS ALLOWED TO TAKE PART IN ANY DODGEBALL EVENT.
PARTICIPANT'S NAME ___________________________________________ DATE OF BIRTH _____________
(please print clearly and legibly)
IN CONSIDERATION of being permitted to participate in any way in the sport and activities of DODGEBALL under the auspices of CommonWealth Press, I acknowledge, appreciate, and agree that:
1. The risk of injury from the activity involved in dodgeball is significant, including the potential for permanent disability and death, and while particular protective equipment and personal discipline will minimize this risk, the risk of serious injury does exist;
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE of those persons released from liability below, and assume full responsibility for my participation; and,
3. I understand that the activities of dodgeball are physically and mentally intense. I understand the rules of play and will comply with all rules and regulations. If I observe any unusual or unnecessary hazard during my participation, I will bring such to the attention of the nearest official as soon as practical; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS CommonWealth Press, other participants, the owners and lessors of premises used to conduct the dodgeball activities, their officers, officials, agents and/or employees ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
5. I understand and agree that this Release of Liability Agreement covers each and every dodgeball activity and event in which I participate hereafter.
6. Said release shall further assign to CommonWealth Press, all right to use any photographs or video of me taken relative to playing the game and corresponding show activities.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
1.________________________________________
2.________________________________________
3.________________________________________
4.________________________________________
5.________________________________________
PARTICIPANT'S SIGNATURES
Date Signed: _____________ Phone #: ___________________
___________________________________________
ADDRESS
______________________________
CITY, STATE
________________
ZIP
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree not only to his/her release of CommonWealth Press, and all other Releasees but also to release and indemnify the Releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heirs, assigns, and next of kin.
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PARENT/GUARDIAN'S SIGNATURE
__________________ __________________
EMERGENCY PHONE #(S)
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DATE