Juk-Ahm

Information Parent/Guardian/Self

Emergency Information

DO NOT SIGN THIS FORM BEFORE YOU READ IT.

ASSUMPTION OF RISK AND LIABILITY WAIVER AND RELEASE:

I, the responsible Party, on my own behalf, on behalf of all those who are listed as Participants under this agreement, including my minor children and, my/their personal representatives, assigns, successors, heirs, and next of kin (hereinafter collectively referred to as “the Releasors”) acknowledge and agree that the use of facilities, services, equipment, or premises of Camp Juk-Ahm (the Camp) by the Releasors involves risk of injury to persons and property.  The Releasors assume full responsibility for such risk to myself/themselves.  In consideration of  being permitted to enter and use the facilities for any purpose, including, but not limited to observation, services, equipment, training or participation in any way, the Releasors agree to the following: the Releasors do hereby release and hold harmless Camp Juk-Ahm, Brad Whitlow, parents, employees, independent contractors and agents from all liability to the Releasors, for any loss or damage.  The Releasors waive any claim or demands therefore based on, or on account of, any physical or mental injury or death to any of the Releasors and property damage, including theft, sustained by any Releasor, whether caused by active or passive negligence of Camp Juk-Ahm or otherwise.  This release of liability includes, but is not limited to claims based on the following:  Camp Juk-Ahm’s improper maintenance of its equipment (mechanical or otherwise), grounds or facilities; Camp Juk-Ahm’s negligent instruction or supervision, including personal training, or inadequate security or staffing while any of the Releasors is in, upon or about Camp Juk-Ahm’s premises; the Releasors use of Camp Juk-Ahm’s facilities, services or equipment; and/or slipping or tripping anywhere in or about the Camp.  Such facilities include but are not limited to: exercise equipment, pavilion area, trails, parking area or any other area.  Such risk of injury includes, but is not limited to injuries arising from the participation by any of the Releasor’s or others in supervised or unsupervised activities at the Camp, injuries and medical disorders, including, but not limited to death, heart attacks, strokes, heat stress, sprains, broken bones, and torn muscles and ligaments, among others, arising from exercising or any recreational use of any of the Camps facilities or while participating in any of the Camp’s programs and, accidental injuries occurring anywhere in or about the Camp, including it’s dressing rooms, showers, and other facilities.  The Releasors also agree to indemnify the Camp from any loss, liability, damage or cost that the Camp may incur due to the presence of any of the Releasors in, upon or about, the Camp’s premises or anyway observing or using any of the Camps facilities, services, or equipment whether caused by the Releasors negligence or otherwise.  The Releasors expressly agree that the foregoing release and waiver of liability and indemnity agreement is intended to be as broad and inclusive as permitted by the law of the state of Tennessee, and that if any portion of the foregoing release and waiver is held invalid, then it is agreed that the remainder of this release and waiver of liability of indemnity agreement shall continue in full force and effect.

I acknowledge that I have carefully read this waiver and release and fully understand that it is a release of liability, and express assumption of risk and indemnity agreement.  I am aware and agree that by executing this waiver and release, I , and all the Releasors are giving up any rights I/they may have to bring a legal action or assert a claim against Camp Juk-Ahm for its negligence or for any defective product on its premises.  I represent that I have the actual authority to, and do hereby enter into this agreement on my behalf and as an authorized agent or parent or legal guardian for all the Releasors.  I have read and voluntarily signed this waiver and release and I further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made to me or any of the Releasors.

I have read and agree to be bound by the terms of this Assumption of Risk and Liability

Waiver and Release, and I acknowledge that a complete copy of this agreement was provided to the Responsible Party when this Agreement was signed.   I further agree to be bound by Camp Juk-Ahm’s Rules and Regulations.

Medical Release and Authorization

As Parent/Guardian of the named participant or the named participant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, for minor child, or myself (if adult participant) in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the adult or minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named participant(s). In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Juk-Ahm. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the adult/child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.