In consideration of your accepting my and/or my family member, and/or child(ren)’s entry, I hereby, for myself, my family members, child(ren), our heirs, assignees, executors and administrators waive and release any and all rights and claims I, my family members, or child(ren) may have now or that may come into existence against the Township of East Brunswick (“Township”) and its elected and appointed officials, representatives, officers, employees, agents, successors and assigns for any and all injuries or illnesses suffered by myself, my family members, or child(ren) during or in connection with any program, event, or activity sponsored by the Township, including the Township’s Department of Recreation and Parks (“Recreation and Parks”), or arising from the use of any of the Township’s property or facilities. I UNDERSTAND AND AGREE that this Waiver and Release includes any claims based on the actions, omissions, or sole negligence of the Township of East Brunswick, its elected and appointed officials, its agents, employees and volunteers and others working on behalf of the Township of East Brunswick.
I hereby acknowledge that my registration fee for any Recreation and Parks program or entry fee for any Township property or facility does not include or entitle myself, my family members, or child(ren) to payment of medical expenses that may arise out of mine, my family members, or child(ren)’s participation in any Recreation and Parks program or use of the Township’s property or facilities. I acknowledge further that I assume responsibility for myself, my family members, and child(ren)’s medical expenses.
I agree that I, my family members, child(ren), and guests will review and comply with all rules and regulations established by the Township with respect to the use of its property and facilities. I further agree to take full responsibility for ensuring that I, my family members, child(ren), or guests comply with these rules and regulations.
I hereby acknowledge that the East Brunswick Department of Recreation and Parks may / may not (circle one) use myself, my family members or child’s photograph or likeness, and mine, my family members, or his/her name(s) in connection with public presentations, advertising, publicity and promotional efforts relating to any Recreation and Parks activities. If one of the preceding options is not circled, it shall be deemed an approval.
In the instance of a medical emergency, I understand that the East Brunswick Recreation and Parks will always attempt to contact the parent/guardian first. I hereby give permission to East Brunswick Recreation and Parks to seek emergency medical treatment including ordering x-rays, routine tests, or to provide or arrange necessary related transportation for myself or child/ward. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. In the event I cannot be reached in an emergency, I hereby give permission to the physician to secure and administer treatment, including hospitalization for myself, my family members, or child/ward. If there is a change in the above information, I will promptly notify East Brunswick Recreation and Parks. This completed form may be photocopied. I further agree that in the event that myself or child(ren) repudiates or attempts to repudiate such release, I will personally indemnify and save harmless the Township of East Brunswick, and its elected and appointed officials, representatives, officers, employees, agents, successors and assigns, for any and all loss and damaged occasioned thereby. I further acknowledge that there is no medical insurance coverage included in my registration for any program offered by the East Brunswick Recreation and Parks and entry fee to any Township property or facility. By participating in these programs or using Township property or facilities, I assume my own insurance responsibilities.
I HAVE READ THIS WAIVER OF LIABILITY AND RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I AM GIVING UP MY RIGHT TO FILE A CLAIM/LAWSUIT, AND VOLUNTARILY AND KNOWINGLY AGREE TO THE TERMS HEREIN.