PLEASE READ THE FOLLOWING CAREFULLY. PLEASE WRITE LEGIBLY. THANK YOU.
ECHOES IN TIME
WORKSHOP IN EARLY LIVING SKILLS
WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in ECHOES IN TIME related events and activities, the undersigned:
- Agree that the member/participant should inspect the facilities and equipment to be used, and if the member/participant believes anything is unsafe, he or she should immediately advise supervisor (advisor, manager, etc) of such condition(s) and refuse to participate.
- Acknowledge and fully understand that each member/participant will be engaging in activities that involve risk or serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions or negligence, but the actions, inaction or negligence of others, or the condition of the premises or of any equipment used. Further, that there may be other risk not known to us or not reasonably foreseeable at this time.
- Assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death.
- Release, waive, discharge and covenant not to sue ECHOES IN TIME, its affiliated clubs, their respective administrators, director, agent, and other employees of the organization, other members/participants, sponsoring agencies. Sponsors, advertisers and if applicable, owners and lessors of premises used to conduct the event, all of which are hereinafter referred to as "releases" from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the release or otherwise.
I have read the above waiver and release, understand that I have given up substantial rights by signing it, and sign it voluntarily.
Print full name ___________________________________________________________
Sign full name ____________________________________________________________
City _____________________________ Zip __________
Home phone ___________________________ Cell phone _________________________
In case of emergency notify __________________________ Phone ______________