Pickleball Open Play

PICKLEBALL OPEN PLAY

If you are under the age of 18, this form must be signed by you as the participant AND by your parent or legal guardian.
Participants Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Is Participant over 18 years old?

YesNo
Level of Experience *
ACTIVITY WAIVER
I assume full responsibility for any and all injuries, damages (both economic and non-economic), and losses of any type, which may occur to me or my guest, and I hereby fully and forever release and discharge St. Stephen Missionary Baptist Church, its insurers, employees, officers, directors, and associates, from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated, or unanticipated, resulting from or arising out the use of said equipment and facilities.I understand and acknowledge that the use of equipment involves risk of serious injury, including permanent disability and death.I understand that St. Stephen Missionary Baptist Church is not responsible for property that is lost, stolen, or damaged while in, on, or about the premises.I understand and comply with all rules imposed by St. Stephen Missionary Baptist Church regarding the use of the facilities and equipment. I conduct myself in a controlled and reasonable manner at all times, and to refrain from using any equipment in a manner inconsistent with its intended design and purpose.I further grant full permission for SSMBC to use any photographs, recordings, or any other record of this event for any purpose.I RELEASE OF LIABILITY AND VOLUNTARILY EXECUTED THIS DOCUMENT WITH FULL KNOWLEDGE OF ITS CONTENT.
My signature acknowledges that I have read the above waiver and I agree and accept all terms and conditions set forth herein.*

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Emergency Contact *

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
In signing the Acknowledgement of Risk and Waiver Liability I hereby acknowledge and represent: (a) that I have read this document in its entirety, understand it, and sign it voluntarily; and (b) that this Acknowledgement of Risk and Waiver of Liability is the entire agreement between the parties hereto and its terms are contractual and not a mere recital.
REQUIRED FOR ALL PARTICIPANTS UNDER 18 YEARS OF AGE:PARENT OR GUARDIAN’S AUTHORIZATION FOR MEDICAL CARE AND CONSENT AGREEMENT
I certify that I am the parent or legal guardian of the above-named participant in the ACTIVITY. On behalf of myself and my spouse, partner, co-guardian or any other person who claims the participant as a dependent, I have read the above agreement, I understand the contents of this Acknowledgement of Risk and Waiver of Liability, assent to its terms and conditions, and sign this Acknowledgement of Risk and Waiver of Liability of my own free act. I acknowledge that my dependent and I have agreed to the terms and conditions of my dependent’s participation in the ACTIVITY, and I hereby give my consent to participation by my dependent in the ACTIVITY, and to receive medical treatment determined to be necessary. I further agree to hold harmless, indemnify and defend SSMBC from and against all claims, demands or suits that my dependent has or may have.
Parent or Guardian Name

First NameLast Name
Parent or Guardian Signature

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Should be Empty:

PICKLEBALL OPEN PLAY

ACTIVITY WAIVER

REQUIRED FOR ALL PARTICIPANTS UNDER 18 YEARS OF AGE:PARENT OR GUARDIAN’S AUTHORIZATION FOR MEDICAL CARE AND CONSENT AGREEMENT