CLARK COUNTY PARKS AND RECREATION

PARTICIPANT INFORMATION FORM & LIABILITY RELEASE

I hereby voluntarily assume and accept all personal responsibility for my or my child's behavior, and for all risk of injury, illness, disease or death, and release any rights or claims for damages and agree to indemnify, defend, and hold harmless CLARK COUNTY, its faculty, agents, and all individuals assisting in facilitating and conducting these activities, from all liability of any nature for any and all injuries, loss or damage suffered at, or in any way connected to participation in this program. This does not preclude SIIS claims from Clark County and other government employees.

My signature below will also indicate that I am aware of the nature and dangers of adventure activities, and I will participate in only those activities that are within my abilities and limitations. I have read, understood and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding hereafter.

EMERGENCY MEDICAL RELEASE (parents/guardian only): In the event that I cannot be reached in an emergency, I hereby authorize Clark County personnel to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child.