Waiver and Release – Adult

1.   I am over the age of 18 and I choose to participate in {programName} held by
TREELINE ENRICHMENT, LLC, on {programDate} (“Activity”).  I sign with the intent to bind myself and my assignees, heirs, next of kin, executors, guardians, and representatives as consideration for participating in the Activity.

 
2.   I am aware that the Activity involves inherent risks and dangers, as defined by Section 744.301, Florida Statutes, which cannot be avoided or eliminated and which may impose physiological effects upon myself including INJURY, DAMAGE, or DEATH.

 
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO ENGAGE IN POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF TREELINE ENRICHMENT, LLC, OR ITS OFFICERS, DIRECTORS, MEMBERS, EMPLOYEES, STOCKHOLDERS, VENDORS, AGENTS, REPRESENTATIVES, AFFILIATES, AND CONTRACTORS (“RELEASEES”) USES REASONABLE CARE IN PROVIDING THE ACTIVITY, THERE IS A CHANCE YOU MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THE ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM, YOU ARE GIVING UP YOUR RIGHT TO RECOVER FROM RELEASEES IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOU OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM AND RELEASEES HAS THE RIGHT TO REFUSE TO LET YOU PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

3.   I hereby WAIVE, DISCHARGE, and agree not to make, assert, or participate in any claim, cause of action, demand, or request for damages, compensation, or other relief, whether known or unknown, against RELEASEES for DEATH, BODILY INJURY, DAMAGE, or any other liability or harm of any sort arising from or involving in any way the inherent risks and dangers associated with the Activity. I intend this waiver to be as broad and inclusive as permitted by law. I HAVE CAREFULLY READ AND UNDERSTAND THIS DOCUMENT. I SIGN IT VOLUNTARILY.

 
4.   This document shall be construed and enforced in accordance with Florida law without reference to its choice of law principles. Any proceeding arising from or involving the Activity or this document shall be subject to the exclusive jurisdiction and venue of the Tenth Judicial Circuit in and for Polk County, Florida. 

In the event of accident or injury to myself or any of my children, or in the event that my spouse, any child of mine, or I become ill or injured while on the premises of TREELINE ENRICHMENT, LLC, or while participating in any activity sponsored by TREELINE ENRICHMENT, LLC, under any circumstances where I am physically unable to consent or am not present:

1. I CONSENT TO THE FURNISHING TO MYSELF, MY SPOUSE, OR ANY OF MY CHILDREN OF MEDICAL CARE AND TREATMENT BY ANY HOSPITAL OR PHYSICIAN THAT THE HOSPITAL OR PHYSICIAN DEEMS NECESSARY OR ADVISABLE. I AUTHORIZE AND CONSENT TO ANY X-RAY EXAMINATION, ANESTHETIC, MEDICAL OR SURGICAL DIAGNOSIS, OR PROCEDURE RENDERED UNDER THE GENERAL OR SPECIFIC SUPERVISION OF ANY MEMBER OF THE MEDICAL STAFF OR OF A DENTIST LICENSED UNDER THE PROVISIONS OF FLORIDA LAW OR ON THE STAFF OF ANY HOSPITAL HOLDING A CURRENT OPERATING CERTIFICATE. IT IS UNDERSTOOD THAT THIS AUTHORIZATION IS GIVEN IN ADVANCE OF ANY SPECIFIC DIAGNOSIS, TREATMENT, OR HOSPITAL CARE BEING REQUIRED, BUT IS GIVEN TO PROVIDE AUTHORITY AND POWER TO RENDER CARE WHICH THE ABOVE-MENTIONED PHYSICIAN IN THE EXERCISE OF HIS OR HER BEST JUDGMENT MAY DEEM ADVISABLE. IT IS UNDERSTOOD THAT EVERY EFFORT WILL BE MADE TO CONTACT THE UNDERSIGNED BEFORE RENDERING TREATMENT TO THE PATIENT, BUT THAT ANY OF THE ABOVE TREATMENT WILL NOT BE WITHHELD IF THE UNDERSIGNED CANNOT BE REACHED.

2. I authorize any officer or member of the TREELINE ENRICHMENT, LLC, or any event volunteer, to consent to such medical care and treatment.

3. I agree to pay the reasonable cost of the medical care and treatment and to indemnify and hold harmless from all liability for such cost the TREELINE ENRICHMENT, LLC, and its officers, directors, members, employees, stockholders, vendors, agents, representatives, affiliates, and contractors.

4. I HAVE CAREFULLY READ AND UNDERSTAND THIS DOCUMENT. I SIGN IT VOLUNTARILY.

5. This document shall be construed and enforced in accordance with Florida law without reference to its choice of law principles. Any proceeding arising from or involving the Activity or this document shall be subject to the exclusive jurisdiction and venue of the Tenth Judicial Circuit in and for Polk County, Florida.