Waiver Form

What type of group are you a part of? Select group type to see Release information.
Organization/Company Name
First and Last Name of Participant
First and Last Name of Participant's Parent/Guardian
Participant's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Participant's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Participant's Email
example@example.com
Parent/Guardian's Email
example@example.com
Date of Event

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I, the participant, understand the nature of Activities facilitated by Group Dynamix and that I am qualified, in good health, and in proper physical condition to participate in such Activities. I further agree and warrant that if at any time I believe the conditions to be unsafe, I will immediately discontinue further participation in the Activities. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless Group Dynamix, its administrators, directors, agents, officers, members, volunteers, team members, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activities take place (“Releasees”), from all liability, claims, demands, losses, or damages on the participant’s account caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise, including negligent rescue operations and further agree that if, despite this release, I, or anyone on my behalf, makes a claim against any of the “Releasees” named above, I will indemnify, save, and hold harmless each of the “Releasees” from any litigation expenses, attorney fees, loss liability, damage, or any cost that may occur as a result of any such claim.
I, the minor’s parent and/or legal guardian, understand the nature of Activities facilitated by Group Dynamix and the minor’s experience and capabilities, and I believe the minor to be qualified, in good health, and in proper physical condition to participate in such Activities, and thereby give my consent that said minor may participate in the Activities. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless Group Dynamix, its administrators, directors, agents, officers, members, volunteers, team members, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activities take place (“Releasees”), from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise, including negligent rescue operations and further agree that if, despite this release, I, the minor’s parent or legal guardian, or anyone on the minor’s behalf, makes a claim against any of the “Releasees” named above, I will indemnify, save, and hold harmless each of the “Releasees” from any litigation expenses, attorney fees, loss liability, damage, or any cost that may occur as a result of any such claim.
Signature
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