AUTHORIZATION AND LIABILITY RELEASE AGREEMENT
I/We, the undersigned ("Participants") and minor family members listed, hereby enter into this authorization and liability release agreement ("Agreement"), in orderfor and IN CONSIDERATION OF being able to participate in any PVBCC-related activities ("Activities") of PVBCC. Activities include, but are not limited to, those occurring at PVBCC facilities, beach events, swimming, sports, games, laser tag, eating, religious activities, strenuous physical activity, physical contact with other participants, basketball, climbing, ropes course, tire swing, night games, disc golf, walking, hiking, lifting, arrow tag, dirt scooters, volleyball, and other seasonally related sports/games and activities, and transportation to and from each activity.
Participation in any PVBCC activity can be physically and mentally intense. I/We understand the rules of play and will comply with all rules and regulations. If we observe any unusual or unnecessary hazard during my/our participation, I/we will bring such to the attention of the nearest official as soon as practical.
DISCLAIMER, ASSUMPTION OF RISK AND WAIVER: I/We acknowledge that participation in the Activities involves risk to myself and my minors and may result in various types of injury including, but not limited to, sickness, including possible exposure to and illness from infectious diseases such as Covid-19 (despite diligent hygiene measures and compliance with the law we cannot guarantee that infectious transmission will not occur), bodily injury, death, emotional injury, personal injury, property damage and financial damage. I/WE VOLUNTARILY ASSUME ALL SUCH RISKS, INCLUDING RISKS KNOWN AND UNKNOWN, OF
INJURIES AND/OR ILLNESSES, HOWEVER CAUSED, EVEN IF CAUSED IN WHOLE OR IN PART BY THE ACTION, INACTION, OR NEGLIGENCE OF PVBCC AND ITS AGENTS, EMPLOYEES, VOLUNTEERS, OFFICERS, DIRECTORS, MEMBERS, AND OTHER REPRESENTATIVES ("RELEASEES") TO THE FULLEST EXTENT OF THE LAW.
ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE.
I/WE HEREBY RELEASE, DISCHARGE AND AGREE TO HOLD HARMLESS, to the fullest extent permitted by law, Releasees, from any and all liability, claims, demands, costs, expenses and compensation arising out of or in any way related to any injury and/or illness or other damage that may result to myself or to members of my family, household, or individuals I invite or for whom I am otherwise responsible while participating in or present at any of the Activities, WHETHER
SCOPE: I/We further acknowledge and accept that Agreement is intended to be as broad and inclusive as permitted by law and agree that if any portion of this Agreement is deemed to be invalid, the remainder will continue in full legal force and effect.
I/We hereby authorize PVBCC and its agents, employees, and volunteers, and the above identified emergency contact to consent to medical, surgical or dental examination and/or treatment, including, but not limited to, X-ray examination, anesthesia, injections, and hospitalization as deemed necessary.
PHOTO/VIDEO CONSENT AND RELEASE:
I/We hereby assign and grant Releasees the right and permission to use, display, and publish photographs, video, electronic representations, and sound recordings made of me and my minors during Activities, and I hereby RELEASE Releasees from any and all liability from such use and publication. I specifically WAIVE allrightsto compensation and approval for any of the foregoing.
CONSENT TO DISCLOSURE OF MEDICAL CONDITION:
To provide proper care and supervision, and to ensure the health and safety of the participants and staff of PVBCC, it will occasionally be necessary to disclose my/our medical condition to those who have a need to know in order to take proper precautions and/or provide treatment. By signing this form, I/We consent to disclosure of my/our medical condition to PVBCC employees, volunteers, officers, directors, and agents, as well as to third parties who may be affected or have a reasonable basisto know, including, but not limited to, parents, children, medical providers, first responders, participants, hosts, facilities managers, and those with whom contact is foreseeable.
RESPONSIBILITY TO KEEP PVBCC INFORMED:
If any of the information I/We have provided on this form changes, I/We agree to promptly inform PVBCC of such changes, and sufficiently in advance for PVBCC to be aware of such changes and reasonably take any action necessary prior to my/our participation in any Activities. I/We also agree to immediately inform PVBCCif I/We have been exposed to any communicable diseases prior to participating in any Activities.