Waiver of Liability and Hold Harmless Agreement
Amtgard
general waiver and informed consent to participate in all Amtgard events and
functions. This
form must be filled out and turned into the Prime Minister before participation
in an Amtgard event or function.
1.
I,
in consideration for myself ____________________________, receiving permission
to participate in Amtgard, hereby release, waive and discharge all people
involved with or associated with Amtgard (hereinafter referred to as RELEASEES)
from any and all liability, claims, demands, actions, and causes of action
whatsoever arising out of or related to any loss, damage, or injury that may be
sustained by myself or to any property in the possession of myself, while
participating in Amtgard, or while in, on, upon, or traveling to or from any
program activity where Amtgard is being conducted.
2.
I
am fully aware of the risks and hazards connected with allowing myself to
participate in this activity, including the risk of physical injury or
disability as the result of such injury, and I hereby allow myself to
voluntarily participate in said activity. I voluntarily assume full
responsibility of any risk of loss, property damage, or personal injury that
may be sustained by myself, or any loss or damage to
property in the possession of myself, as a result of being engaged in such
activity.
3.
I
further agree to indemnify and hold harmless the Releasees
from any loss, liability, damage, or costs that may incur due to my
participation in said activity.
4.
It
is my express intent that this Waiver of Liability and Hold Harmless Agreement
shall bind the members of my family and spouse (if any), if I am alive, and my
heirs, assigns, and personal representatives, if I am not alive, and shall be
deemed a release, waiver, and discharge above named Releasees.
I hereby further agree that this Waiver of Liability and Hold Harmless
Agreement shall be construed in accordance with the state laws of
5.
I
understand the Releasees will not be held responsible
for any medical costs associated with an injury myself
may sustain.
6.
I
further agree to become familiar with the rules and regulations for my conduct
and agree that I will not violate said rules or any directive or instruction
made by the persons in charge of said program and that I will further assume
the complete risk of any activity done in violation of said rule, directive, or
instruction.
7.
I
also understand that I am urged to obtain adequate health and accident
insurance to cover any personal injury to myself which may be sustained during
the program or transportation to or from said program and activities.
In signing this release,
I acknowledge and represent that I have read the foregoing Waiver of Liability
and Hold Harmless Agreement, understand it, and sign it voluntarily as my own
free act and deed: no oral representations, statements, or inducements, apart
from the foregoing agreement have been made; I am at least eighteen (18) years
of age and fully competent; and I execute the release for full, adequate, and
complete consideration, fully intending to be bound by the same.
Signature |
Date Signed |
Signature of legal guardian if under 18 |
Date Signed |
Please Print:
Mundane (real) name |
Date of Birth |
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Street address, City, State, Zip, Apt# |
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Home Phone Number |
Work Phone Number |
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Email Address |
Pager Number |
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Emergency Contact Name, Relationship, and Phone Number |
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Amtgard Persona Name/Alias (if known) |
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