I acknowledge, to the best of my knowledge, all information provide on this form is accurate and complete. The person described had my full permission to participate in the activity and is in good health.
I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury, including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.
In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by activity sponsor to hospitalize, secured proper treatment for, and to order injection and/or anesthesia and/or surgery for the above named.
In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent or guardians, if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for an injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or it’s agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”) Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising, directly or indirectly, out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.
If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.