ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
I hereby assume all risks of participating in this "Rhode Island Relics Annual Pound the Ground” Including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them, or because of their possible liability without fault. I certify that I am physically fit and have not been advised to abstain from participating in this event by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this Rhode Island Relics Pound the Ground event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the organizers of the Rhode Island Relics Pound the Ground event in which I will be participating and that it will govern my actions and responsibilities at said event.
I hereby assume responsibility for myself, my executors, administrators. heirs. next of kin, successors. and assigns as follows: (ALL WAIVE, RELEASE, AND DISCHARGE) from any and all liability,including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability. personal injury, property damage; property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event. THE FOLLOWING ENTITIES OR PERSONS: ALL Rhode Island Relics-Nathan Matthews, affiliates/employees/volunteers/rental companies, brewery and food truck vendors of said event, Town of Chazy NY, the property owner and all of his employees or affiliates.
ANY affiliated parties will be released from ALL LIABILITY after my signing of this document (B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this (Rhode Island Relics Annual Pound The Ground) or any other event held by Rhode Island Relics, whether caused by
negligence or otherwise. I acknowledge that this Rhode Island Relics, the property owner or The Town of Chazy, NY event may carry with it the· potential for death, serious injury, and personal loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants equipment, vehicular traffic, actions of other people: including, but not limited to participants, volunteers, spectators, vendors and lack of hydration.
I consent and agree that Rhode Island Relics, the property owner and The Town of Chazy, NY or their group members, agents, representative vendors or volunteers may take photographs or digital recordings of me as a participant during this event and use these/ any and all media for promotional purposes, I further consent that my identity could be revealed within or by description text or commentary, I waive any rights, claims or interest and I understand that there will be no financial compensation for the release of my image or likeness.
The accident waiver, release of liability and image release shall be construed broadly as a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY ANO A CONTRACT ANO I SIGN ON MY OWN FREE WILL.
Print Participant's Name and Age Signature (if under 18 years Parent or Guardian must sign) Date PARENT/GUARDIAN WAIVER FOR MINORS (under 18 years old) The Undersigned parent and or natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward's participation in the Rhode Island Relics 2nd Annual Pound the Ground and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect on lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
Print Participant's Name and Age Signature (if under 18 years Parent or Guardian must sign)
Printed Name: _________________________________________________________