(THIS FIRST PAGE IS NOT TO FILL OUT, JUST TO READ. THE FORM RESPONSES IN THE NEXT PAGE FILL THE BLANKS)
This Waiver of Liability and Hold Harmless ("Waiver") made on this day of ______________ by and between _________________________ ("Parent/Legal Guardian” ) and Daniela P. Vidal and Flips and Friends ("Releasee"), together referred to as the "Parties." This waiver is being signed on behalf of _____________________ ("Participant"/"Minor").
WITNESSETH
1. In consideration for volunteering to participate in any and all activities prepared by Flips & Friends Inc., including but not limited to Gymnastics, Tumbling, Trampoline, Open Play, Summer Camp, and any other specialized classes. I __________________________ hereby RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE AND HOLD HARMLESS: Flips and Friends, Inc., including Daniela P. Vidal, and any employee, contractor, representative, associate, officer, agent, and volunteer from any and all liability, claims, demands, action, judgements, costs, expenses, court costs, attorney fees and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE, or otherwise and regardless of whether such liability arises in tort, contract, strict liability, or otherwise, to the fullest extent allowed by law, while participating in such activity, or while in, on, or upon the premises where the activity is being conducted.
2. MEDIA RELEASE. I hereby also authorize Flips & Friends Inc. to use my likeness in photographs or video recordings in any and all of its publications. I understand and agree any media using my likeness will become property of Flips & Friends Inc., and will not be returned. I understand that since my participation at Flips & Friends is voluntary, I will receive no financial compensation.
3. ASSUMPTION OF RISKS. PARENT/GUARDIAN hereby elects to voluntarily have the 'Participant' in said activity, and engage in such activity knowing that certain risk of harm are, or may be inherent, in the various activities contemplated herein and that the activity may be hazardous to me and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEE or otherwise.
PARENT/LEGAL GUARDIAN ACKNOWLEDGES the following RISKS while participating at Flips & Friends, which include but are not limited to: (1) slipping and falling; (2) collision with any of the following: fixed objects and/or other people; (3) sprains, fractures, scrapes, bruises, dislocations; (4) PARTICIPANT sense of balance, physical coordination, ability to operate equipment and/or follow directions; (5) injuries to head, back, and neck; (6) paralysis and/or death.
4. PARENT/LEGAL GUARDIAN has been advised and warned of the RISKS pertaining to the ASSUMPTION AND ACKNOWLEDGEMENT OF RISKS AND RELEASE OF LIABILITY. Those provisions are incorporated herein by reference as if set forth in full. PARENT/LEGAL GUARDIAN HEREBY REPRESENTS AND CERTIFIES THAT HE/SHE HAS READ THE ASSUMPTION AND ACKNOWLEDGMENT OF RISKS AND RELEASE OF LIABILITY PROVISIONS AND THAT HE/SHE UNDERSTANDS THAT BY SIGNING THIS DOCUMENT HE/SHE IS WAIVING VALUABLE LEGAL RIGHTS INCLUDING ANY AND ALL RIGHTS THAT HE/SHE MAY HAVE AGAINST RELEASEE.
5. RELEASE OF LIABILITY. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEE from any loss, liability, damage, demands, liens, liabilities, judgments, or costs, including court costs and attorney fees, that they may incur due to my participation in said activity, WHETHER CAUSED BY OR CONTRIBUTED TO IN WHOLE OR PART by any action or failure to act, negligence, breach of contract, or other misconduct on the part of RELEASEE or otherwise. It is understood that this INDEMNIFICATION AND HOLD HARMLESS shall apply to any action or failure to act, negligence, breach of contract, or other misconduct on the part of RELEASOR to thirdparties.
6. It is my express intent that this Waiver and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives or executors, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above named RELEASEE. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Florida and consent to the exclusive jurisdiction of the federal and state courts located in Miami Dade County, Florida. Nothing in this Agreement shall be interpreted as a waiver or limitation of any rights, defenses, immunities, or protections available to the Releasee under applicable federal or Florida law.
7. MEDICAL AUTHORIZATION. In the event of injury or medical emergency, I authorize Flips & Friends staff to obtain medical treatment for the participant and agree to be responsible for any resulting medical expenses.
8. WAIVER OF JURY TRIAL. I, as the parent or legal guardian of the minor participant, knowingly and voluntarily waive any right to a trial by jury in any action, proceeding, or counterclaim arising out of or relating to the minor’s participation in activities at Flips & Friends.
8. This Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Florida. If any provision of this Agreement is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.
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ACKNOWLEDGMENT. IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THE ENTIRE WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT, UNDERSTAND IT, 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 AM AT LEAST EIGHTEEN (18) YEARS OF AGE AND FULLY COMPETENT; I UNDERSTAND THAT I AM GIVING UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO MAINTAIN A LAWSUIT AGAINST FLIPS AND FRIENDS, INC., FOR INJURIES OR DAMAGES ARISING FROM THE MINE OR THE MINOR'S PARTICIPATION IN ACTIVITIES AT THE FACILITY, TO THE FULLEST EXTENT PERMITTED BY FLORIDA LAW.
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PARENT/LEGAL GUARDIAN NAME
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PARENT/LEGAL GUARDIAN SIGNATURE
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PARENT/LEGAL GUARDIAN EMAIL ADDRESS
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PARENT/LEGAL GUARDIAN PHONE NUMBER
EMERGENCY CONTACT INFORMATION
NAME: _________________________
RELATIONSHIP: _________________________
PHONE NUMBER: _________________________
CELL PHONE: _________________________
EMAIL: _________________________
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