RELEASE AND WAIVER OF LIABILITY ASSUMPTION OF FULL RESPONSIBILITY FOR ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE AND INDEMNITY AGREEMENT

Participants Name:

First NameLast Name

Date of Birth:

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Parent / Guardian Name:

First NameLast Name

Address:

Street Address

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Phone Number:

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Email

example@example.com

This waiver is for:

For group visits, please enter name of group / school / daycare:

Health Insurance Information:

Insurance Provider:

Policy Holder:

Policy Number:

RELEASE AND WAIVER OF LIABILITYASSUMPTION OF FULL RESPONSIBILITY FOR ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE AND INDEMNITY AGREEMENT As consideration for being allowed to enter the play area and/or participate in any party and/or class or program at Paramount Sports complex the undersigned, on his or her behalf, and on the participant(s) identified below, acknowledges, understands, and aggress to the following: 1) I represent that I am the parent or legal guardian of the Participant(s) named below or I have obtained permission from the parent/legal guardian of the Participant(s) named below to execute this agreement on their behalf. 2) There are risks and dangers associated with participation in any and all activities, which could result in, but are not limited to, bodily injury, partial and/or total disability and death. 3) I, as the minor participant, have no physical or mental condition which would interfere with my ability to participate in or attend any such event or activity, or that would endanger my health or safety. 4) I am warranting that my minor child has no mental or physical condition that would interfere with his/her ability to participate in or attend any such event or activity, or that would endanger his/her health or safety. 5) The social and economic losses and/or damages, which could result from those risks and dangers described above from said participation in any and all activities, could be severe. 6) These risks and dangers may be caused by the actions, inaction, negligence or carelessness on the part of Paramount Sports Complex, Inc., or any of its officers, agents, servants, or employees. 7) There may be other dangers and risks from said participation in any and all activities not known to us or not foreseeable at this time. IN CONSIDERATION of permitting the undersigned and/or myself to participate in any and all activities at Paramount Sports Complex, Inc. in the City of Annville, County of Lebanon, and the State of Pennsylvania, the undersigned agrees for himself/herself, his/her family, his/her heirs, administrators and assigns, and voluntarily releases, discharges and promises not to sue and not to hold liable Paramount Sports Complex, Inc. or any of its officers, agents, servants or employees for any and all claims for personal injury, property damages or wrongful death occurring to himself/herself arising out of engaging (or receiving instructions) in said activity or any activities incidental thereto whenever or however it may occur and for whatever period the activities or instructions may continue and whether it is caused by the negligence or carelessness, or otherwise, of the persons or entities conducting or sponsoring the event or instruction . It is my intention by this document to relieve Paramount Sports Complex, Inc. or any of its officers, agents, servants, or employees from any responsibility for personal injury, property damage or wrongful death whether caused by the negligence, carelessness, or otherwise, of the persons or entities mentioned above. I also understand that I am responsible for any and all medical expenses that may arise from involvement in any and all activities at Paramount Sports Complex. I attest that I have proper medical coverage and medical insurance coverage for the individual(s) stated on this waiver. In the event I do not have medical coverage or medical insurance coverage or sufficient coverage, I acknowledge that I am responsible for ALL MEDICAL EXPENSES, INCLUDING ANY AND ALL DEDUCTIBLES. I UNDERSTAND I AM ASSUMING ALL RISKS INHERENT WITH ANY AND ALL ACTIVITIES THAT I AM PARTICIPATING IN, WHETHER KNOWN OR UNKNOWN, AND THAT BY SIGNING THIS DOCUMENT I AM GIVING UP MY RIGHT TO SUE PARAMOUNT SPORTS COMPLEX, INC., WHETHER CAUSED BY THE NEGLIGENCE OF THE SAID PERSONS OR ENTITIES. I VOLUNTARILY SIGN MY NAME EVIDENCING MY ACCEPTANCE OF THE ABOVE PROVISIONS, AND FURTHER AGREE THAT NO ORAL REPRESENTATION, STATEMENTS OR INDUCEMENTS APART FROM THE AGREEMENT HAVE BEEN MADE. I HAVE READ THE DOCUMENT. I UNDERSTAND IT IS A RELEASE OF ALL CLAIMS. Please print name:

Parent or Legal Guardian Signature:

Date:

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