Greetings, all!
Some time ago many of you were kind enough to respond to my request for a
participant release form/waiver of liability. A few people requested the
compilation of responses, and at long last I can finally comply.
Thanks, again, for taking the time to help me out! The final form is the
one my board recently approved.
-Sharon
Yoga Date:
WAIVER OF LIABILITY
In consideration of the valuable programs offered to me as a guest of the
Grand Traverse County Senior Center Network (hereinafter “Senior Center”),
I agree to all of the following terms and conditions:
(1) ACKNOWLEDGEMENT AND ACCEPTANCE OF RISKS AND RESPONSIBILITIES
I understand that participating in any program that involves physical
activity or travel, including but not limited to sports, athletic,
exercise, wellness, health, entertainment, social, or travel programs,
involves certain risks and dangers including serious injury or death. I
acknowledge that I am aware of these risks and accept all responsibility
for any damages or personal injury that may occur as a result of my
participation in such activities.
(2) RELEASE AND WAIVER OF LIABILITY
I agree to release Grand Traverse County and all of its elected and
appointed officials, employees, volunteers, representatives and agents from
any and all liability, claims, demands, actions or rights of action,
including but not limited to claims for injury, wrongful death, property
damage, stolen or lost property, which are related in any way to or are in
any way connected with my participation in programs offered to me by the
Senior Center.
I also acknowledge that the Senior Center sometimes employs independent
contractors to provide its program services. The Senior Center does not
assume responsibility for the actions of its independent program service
providers. These program service providers serve as independent contractors
and are not employees or agents of the Senior Center. Any damages resulting
from their actions are the sole responsibility of the independent program
service provider.
I also understand that this release of liability is binding upon not only
myself but also my heirs, executers and assigns. My initials or signature
below indicates that I have read this entire document, I understand it
completely, and agree to be bound by its terms.
FITNESS OVER 50 Date:
WAIVER OF LIABILITY
In consideration of the valuable programs offered to me as a guest of the
Grand Traverse County Senior Center Network (hereinafter “Senior Center”),
I agree to all of the following terms and conditions:
(1) ACKNOWLEDGEMENT AND ACCEPTANCE OF RISKS AND RESPONSIBILITIES
I understand that participating in any program that involves physical
activity or travel, including but not limited to sports, athletic,
exercise, wellness, health, entertainment, social, or travel programs,
involves certain risks and dangers including serious injury or death. I
acknowledge that I am aware of these risks and accept all responsibility
for any damages or personal injury that may occur as a result of my
participation in such activities.
(2) RELEASE AND WAIVER OF LIABILITY
I agree to release Grand Traverse County and all of its elected and
appointed officials, employees, volunteers, representatives and agents from
any and all liability, claims, demands, actions or rights of action,
including but not limited to claims for injury, wrongful death, property
damage, stolen or lost property, which are related in any way to or are in
any way connected with my participation in programs offered to me by the
Senior Center.
I also acknowledge that the Senior Center sometimes employs independent
contractors to provide its program services. The Senior Center does not
assume responsibility for the actions of its independent program service
providers. These program service providers serve as independent contractors
and are not employees or agents of the Senior Center. Any damages resulting
from their actions are the sole responsibility of the independent program
service provider.
I also understand that this release of liability is binding upon not only
myself but also my heirs, executers and assigns. My initials or signature
below indicates that I have read this entire document, I understand it
completely, and agree to be bound by its terms.
Informed Consent and Liability Waiver Release for Participation in Exercise
Program
I agree and consent to the following:
I am voluntarily participating in the Roaming Readers Walking Club program
conducted by the Eureka Public Library District. I recognize that the
program requires physical exertion that may be strenuous at times and may
cause physical injury, and I am fully aware of the risks and hazards
involved.
I understand that it is my responsibility to consult with a physician prior
to and regarding my participation in the above mentioned program. I
represent and warrant that I have no medical condition that would prevent
my participation in the program.
I agree to assume full responsibility for any risks, injuries, or damage
known or unknown which I might incur as a result of participating in the
program. Such injuries may include, but are not limited to, heart attacks,
muscle strains, muscle pulls, muscle tears, broken bones, shin splints,
heat prostration, injuries to knees, injuries to back, injuries to foot, or
any other illness or soreness, including death.
I knowingly, voluntarily, and expressly waive any claim I may have against
the Eureka Public Library Dis-trict for injury or damages that I may
sustain as a result of participating in the program.
I, my heirs or representatives forever release, waive, discharge, and
covenant not to sue the Eureka Public Library District for any injury or
death caused by their negligence or other acts.
I have read the above waiver and release liability and fully understand its
contents. I voluntarily agree to the terms and conditions stated above.
______________________________________________
Date:___________________________
Signature
Print Name: _______________________________________________
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY
I ____________________________________________(Participant) HEREBY AGREE
TO THE FOLLOWING:
Participant is aware that participation in yoga may result in accident or
injury. Participant assumes the risk connected with the participation in
yoga and represents that Participant is in good health and suffers no
physical impairment which would limit participation. Participant
acknowledges that the instructor will not render any medical services
including medical diagnosis of the Participant’s physical condition.
Participant specifically agrees the Kennebunk Free Library and its members
shall not be liable for any claim, demand, cause of action of any kind
resulting from or related to Participant’s participation in the yoga class
offered.
I hereby agree to irrevocably release and waive any claims that I have now
or hereafter may have against Susan Mirisola (Instructor) or the Kennebunk
Free Library.
I have read the above release and waiver of liability and fully understand
its contents. I voluntarily agree to the terms and conditions stated above.
____________________________________________, As Legal Guardian of
(Print Name)
_______________________________(Participant), I consent to the above terms
and conditions.
__________
__________________________________________________________
Date Signature of Parent/Guardian of Participant
Informed Consent and Liability Waiver Release for
Participation in Exercise Program
I agree and consent to the following:
I am voluntarily participating in the Yoga program conducted by the
Watervliet District Library.
I recognize that the program requires physical exertion that may be
strenuous at times and may cause physical injury, and I am fully aware of
the risks and hazards involved.
I understand that it is my responsibility to consult with a physician prior
to and regarding my participation in the above mentioned program. I
represent and warrant that I have no medical condition that would prevent
my participation in the program.
I agree to assume full responsibility for any risks, injuries, or damage
known or unknown which I might incur as a result of participating in the
program.
I knowingly, voluntarily, and expressly waive any claim I may have against
the Watervliet District Library for injury or damages that I may sustain as
a result of participating in the program.
I, my heirs or representatives forever release, waive, discharge, and
covenant not to sue the Watervliet District Library for any injury or death
caused by their negligence or other acts.
I have read the above waiver and release liability and fully understand its
contents. I voluntarily agree to the terms and conditions stated above.
______________________________________________
Date:___________________________
Signature
Print Name: _______________________________________________
Contact
information:__________________________________________________________
--
Sharon Crotser-Toy
Director
*Watervliet District Library*
333 N. Main Street
Watervliet, MI 49098
269-463-6382
Connects People, Inspires Ideas, Transforms Lives
