Release Of Liability

Step 1 of 8

- Hidden
  
  Date
  
  DD slash MM slash YYYY
- User Email*
- What activity is this release of liability being created for?
- Enter Activity:
- What is the name of the party being released from liability?
- Enter Party Name:
- PDF Preview

- What is the address of the party being released from liability?
- Enter Address:
  
  Enter City:
  
  Select State:
  
  Enter Zip Code:
- Would you like to create a release of liability form for a specific person participating in the activity or a release of liability form to be filled out by the participant at a later time?
- Select:
- PDF Preview

- Who is the person participating in the activity?
- Enter Participant Name:
  
  Enter Address:
  
  Enter City:
  
  Select State:
  
  Enter Zip Code:
- PDF Preview

- Is the Participant a minor?
- Select if Participant is a Minor:
  - Yes
  - No
- What is the name of the minor's parent or guardian signing this release?:
- What is the adult's relationship to the minor?:
- PDF Preview

- Who is the participant's emergency contact?
- Enter Emergency Contact Name:
- Enter Contact Relationship to Participant:
- Enter Contact Telephone Number:
- PDF Preview

- Would you like to include a second emergency contact?
- Second Emergency Contact:
  - Yes
  - No
- Second Emergency Contact Name:
- Second Relationship:
- Second Telephone Number:
- PDF Preview

- Would you like to include a third emergency contact?
- Third Emergency Contact:
  - Yes
  - No
- Enter Third Contact Name:
- Enter Third Relationship:
- Enter Third Telephone Number:
- PDF Preview

PDF Preview

WAIVER AND RELEASE OF LIABILITY

In consideration of the risk of injury that exists while participating in ${input_4_2} (hereinafter the “Activity”); and

In consideration of my desire to participate in said Activity and being given the right to participate in same;

I HEREBY , for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, “Releasor,” “I” or “me”, which terms shall also include Releasor’s parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and

I HEREBY release and forever discharge ${input_4_7} , located at ${input_4_10_1} , ${input_4_10_3} , ${input_4_10_4} , ${input_4_10_5} their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively “Releasees”), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS’ NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY.

I further agree to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs.

I further acknowledge that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize ${input_4_7} to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

I further acknowledge that this Activity may involve a test of a person’s physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the ${input_4_7} official or agent, regarding my approval to participate in the Activity.

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS “WAIVER AND RELEASE” AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE ${input_4_7} AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST ${input_4_7} FOR PERSONAL INJURY OR PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of ${input_4_7} , its agents, and employees.

I agree that this Release shall be governed for all purposes by Alabama law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements.

In the event that any damage to equipment or facilities occurs as a result of my or my family’s or my agent’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness.

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION.

Release Of Liability

Step 1 of 8

What activity is this release of liability being created for?

What is the name of the party being released from liability?

What is the address of the party being released from liability?

Would you like to create a release of liability form for a specific person participating in the activity or a release of liability form to be filled out by the participant at a later time?

Who is the person participating in the activity?

Is the Participant a minor?

Who is the participant's emergency contact?

Would you like to include a second emergency contact?

Would you like to include a third emergency contact?