RELEASE OF LIABILITY, WAIVER OF CLAIMS,
ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
(Hereinafter referred to as the “Release Agreement”)
BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS ON YOUR OWN BEHALF AND ON BEHALF OF THE CHILD/CHILDREN, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT. PLEASE READ CAREFULLY! Initial: ___
PARTICIPANT AND PARENT INFORMATION:
Child(ren)’s Full Name(s) (LAST, First, Middle) and Date(s) of Birth: _______________________________________________D.O.B.: __________________
_______________________________________________D.O.B.: __________________
_______________________________________________D.O.B.: __________________
(referred to in this Release Agreement as “Child/Children”)
Full Name(s) of Parent(s)/Guardian(s): ______________________________________________________________________
(referred to in this Release Agreement as “Parent(s)/Guardian(s)”)
Address: _________________________________________________________________________________
Mailing address (if different from above): _____________________________________________________
Telephone number(s): __________________________________________________
TO: Devonne Dylewski and Micaela MacDougall doing business as Water Waves of 296 power st Penticton V2A5X1
In consideration of Water Waves agreeing to participation of the Child/Children in in the Lessons and permitting the Child/Children use of their equipment and services, and for other good and valuable consideration hereby confirmed as received, I/we warrant and agree as follows:
- PARENT/GUARDIAN: I/We am/are the parent(s)/guardian(s) having full legal responsibility for decisions regarding the Child/Children.
- INTERPRETAION: In this Release Agreement,
“Lessons” means any and all activities, events and services provided, arranged, organized, and/or authorized by the Water Waves and includes, but is not limited to, swimming lessons and first aid lessons; and
“Water Waves” means Devonne Dylewski, Micaela MacDougall, and their employees, contractors, agents, representatives, successors, and assigns.
- RULES: I/We understand, and will instruct the Child/Children, that all applicable rules for participation and the instructors’ directions must be followed and that at all times the sole responsibility for personal safety remains with the Child/Children.
- MEDICAL DISCLAIMER: I/We certify that the Child/Children do(es) not suffer from any conditions which may endanger the safety of the Child/Children or anyone else, by participating in the Lessons. I/We further certify that the Child/Children do(es) not suffer from extreme asthma, epilepsy, a cardio/respiratory disorder, hypertension, any skeletal or joint or ligament problem or condition.
- PHOTOS/VIDEOS: I/We hereby agree and acknowledge that Water Waves may take photographs and/or videos of me/us and/or the Child/Children during his/her/their participation in the Lessons (the “Images”). These Images and any intellectual property interest in the Images are the sole property of Water Waves and I/We confirm my/our consent to Water Waves using the Images for the purposes of advertising, promotional, marketing materials or in such other manner as Water Waves deems advisable.
- DAMAGED/ LOST/ STOLEN PROPERTY: I/We hereby agree and acknowledge that Water Waves bears no responsibility to supervise or store any property of myself/ourselves or the Child/Children and any property that I/we bring to the Lessons remain at my/our sole risk and responsibility. At no time will Water Waves be considered a bailiff of my/our property or the Child/Children’s property.
- DAMAGE DEPOSIT/SECURITY: I/We acknowledge that, during the Lessons, the Child/Children may have access or use of certain equipment of Water Waves. As such, I/we agree to compensate Water Waves for any loss or damage of equipment caused by the Child/Children. The assessment of loss or damage, cost of repair or replacement of such loss or damaged equipment, and allocation amongst participants will be at the sole and unfettered discretion of Water Waves.
As security against such loss or damage to Equipment, I/we consent to Water Waves retaining a copy of my/our valid credit card as well as a copy of my/our photo identification for the sole purpose of charging any loss or damage costs. Water Waves will keep such personal information secure and private and will not release to anyone other than Water Waves and for the purposes specifically outlined herein.
- INDEMNITY: I/we hold harmless and indemnify Water Waves from any and all liability, including Water Waves’ actual legal costs, for any personal injury, death, or property damage occasioned to or suffered by any person or persons resulting from the Child/Children’s participation in the Lessons.
I/We freely accept to indemnify and/or reimburse Water Waves for any damages, legal fees, or other costs Water Waves incurs as a result of any claims or lawsuits brought on by the Child/Children against Water Waves for any injury suffered by the Child/Children as a result of the Child/Children’s participation in the Lessons.
- RELEASE OF LIABILITY & WAIVER OF CLAIMS:I/we waive any and all claims that the Child/Children and/or I/we have or may in the future have against Water Waves and release Water Waves from any and all liability for any loss, damage, expense or injury, including death, that the Child/Children and I/we may suffer or that our next of kin may suffer, as a result of the Child/Children’s participation in the Lessons, due to any cause whatsoever, including negligence, gross negligence, breach of contract, or breach of any statutory or other duty of care on the part of Water Waves.
I/weunderstand that negligence includes failure on the part of Water Waves to take reasonable steps to safeguard or protect the Child/Children from or warn the Child/Children of the risks, dangers and hazards of participating in the Lessons.
- ASSUMPTION OF RISKS: The Child/Children and I/we am/are aware that participating in the Lessons is risky and involves a high possibility of serious injury or death which may result from negligence on the part of Water Waves.
I/we, on behalf ofthe Child/Children and myself/ourselves, freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, property damage and loss resulting therefrom.
- JOINT AND SEVERAL: All parties signing this Release Agreement have joint and several liability.
- ENFORCEABILITY: In the event any portion of this Release Agreement is found to be invalid or unenforceable, the remainder shall remain in full force and effect.
- HEIRS & EXECUTORS: This Release Agreement shall be effective and binding upon my/our and the Child/Children’s heirs, next of kin, executors, administrators, assigns and representatives, in the event of my/our and the Child/Children’s death and/or incapacity.
In entering into this Release Agreement, I/we am/are not relying on any oral or written representations or statements made by Water Waves with respect to the safety of participating in the Lessons, other than what is set forth in this Release Agreement.
Signature of Parent(s)/Guardian(s): DATE: _____/_____/______ ___________________________________
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