This form must be completed, signed and submitted prior to participating in the program. Please share this form with all of your participants to complete. You will receive a QR code via email for your sharing convenience.

Anyone who submits a form should be aware that in accordance with the North Carolina Public Records law, found in North Carolina General Statutes Chapter 132, their e-mail address is considered public record.

Waiver of Liability / Certificate of Participation

I, {name}, understand that participating in the program listed below involves risk of injury. These risks may include effects of inclement weather, accidents, contacts with or actions of other participants, or slips/trips/falls, among others. I choose for myself or for my child to participate in the program despite the risks. By signing below, I acknowledge all risks, and I assume all responsibility of injury, illness or death in any way connected to the program. I acknowledge that I am not covered by any City of Greensboro insurance policy. In return for the opportunity to participate in the program, I agree for myself or my child and for my heirs, assigns, executors, and administrators to release, acquit, waive, and forever discharge any legal rights I may have to seek payment or relief of any kind from the City of Greensboro, its officers, employees, agents, or its volunteers for injury, illness, death, or property loss resulting from participation in the program.

 

I also agree not to sue the City of Greensboro, its officers, employees, agents, or its volunteers and to indemnify and save harmless the City of Greensboro, its officers, employees, agents, or its volunteers against all claims, actions, lawsuits and demands, including reasonable attorney fees, made by anyone for any damages, losses or injuries of any kind, including environmental, which may result from participation in the program. Permission is given for any emergency medical treatment which might become necessary, and I agree to be responsible for the expense of medical treatment or service.

 

If I am registering a child for the program, I agree that I am a parent, legal guardian, or am otherwise responsible for the child, and that I release waive, and discharge any legal rights that I may request on behalf of the child participant.

 

Image Release: I hereby consent to allow the exclusive use of, and relinquish all rights to, photographs, recordings, and reproductions in any manner of the likeness, voice, and/or activities of the participant and further authorize the City of Greensboro, its agents or assigns, to make unlimited use of such reproductions, including but not limited to print and/or electronically, broadcasting of the reproduction over radio, television, or on the internet with or without a name for any lawful purpose. I acknowledge that no compensation will be provided for such use by the City. I understand this release shall remain in effect unless a subsequent written notification is provided by the City. I understand that the City of Greensboro assumes no responsibility for my participation in this program.

 

I understand that the City of Greensboro assumes no responsibility for my participation in this program.

Submissions are automatically sent to City staff, there are no additional steps after this form has been submitted.

Please use this QR code to share this form with other participants in your event.