BY SIGNING THIS FORM, YOU WILL WAIVE CERTAIN RIGHTS ON BEHALF OF YOURSELF AND YOUR CHILD. PLEASE READ CAREFULLY.

I, the undersigned, on behalf of myself and my child, understand and acknowledge that participation in this activity may involve the risk of serious injury which may result not only from my/my child's actions, but also from the actions, inactions or negligence of others, the condition of the facilities, equipment or areas where the program is being conducted, or the nature of the program itself. I, on behalf of myself and my child, understand and acknowledge that my child and/or are voluntarily participating in the program(s) with knowledge of the danger involved, and agree to accept and assume any and all risks of personal injury, wrongful death, property damage or other loss from participation in the programs and/or activities.

To the greatest extent permitted by law, I, in consideration of my/my child's participation in this activity, and intending to belegally bound for my child, myself, my heirs, executor and administrators, do hereby release and discharge the City of Claremont and their respective officers, directors, employees, volunteers, partners and contractors, jointly and severally, from any and all liability from personal injury, accident, illness, death, property damage or other occurrence, which I or my child may suffer in any manner whatsoever arising out of or resulting from my/my child's' participation in the above mentioned program(s), and I expressly assume ALL risks of my/my child's participation in this activity, including, without limitation, injury as a result of the acts or omissions of the above parties or some defect in or on their property of anyof them, whether caused by negligence or otherwise, except for illness and injury resulting directly from solely gross negligence or willful misconduct on the part of the City or its employees, and I agree to indemnify, save, hold harmless and defend each and every of the above parties of and from any and all loss, damages, expenses, costs, and attorney's fees arising out of or resulting from my child's participation in this activity.

 

PHOTOGRAPHY AND VIDEO RELEASE

As a participant involved in a City of Claremont Human Services program/class, I and/or my child may be photographed and or video recorded and such photographs/video recordings may be used to publicize City programs/classes without compensation and without further permission. The City has my consent to photograph me and/or my child participating in the activities for use in future City publicity. I understand and acknowledge that my child and !will not receive compensation for such use.

 

EMERGENCY RELEASE

In the event of injury or acute illness, I hereby authorize Claremont Human Services staff to call emergency services to arrange for necessary emergency medical care for me/my child. I understand and acknowledge that - will be responsible for payment of all medical services rendered, including reimbursement to the City for any medical expenses incurred in the care of myself/my child. I agree to accept responsibility for the cost of the above medical services. It is also understood that the City will make a conscientious effort to notify me or the emergency contact designated on this form before incurring such

 

I HAVE CAREFULLY READ THIS WAIVER, RELEASE OF LIABILITY, AND ASSUMPTION OF RISK AGREEMENT AND UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS DOCUMENT RELIEVES THE CITY AND OTHERS FROM LIABILITY FOR PERSONAL INJURY, WRONGFUL DEATH AND PROPERTY DAMAGE, AND, ON BEHALF OF MYSELF AND MY CHILD, SIGN IT VOLUNTARILY.