SAMBA SPORTS ARENA

WAIVER OF LIABILITY

 

PLAYERS NAME: ______________________________________________________

ADDRESS ______________________________ CITY ____________ ZIP _________

DATE OF BIRTH _______ / ______ / ______ PHONE# (_______) _______________

EMERGENCY CONTACT Name:_____________________ Ph#_________________

RELATIONSHIP TO PARTICIPANT ______________________________________

Email __________________________________________________________________

 

SIGNATURE indicates you have Read & are in agreement with SAMBA SPORTS ARENA  “RULES & POLICIES “and SAMBA SPORTS ARENA “WAIVER OF LIABILITY”

Release and waiver of liability, assumption of risk and indemnity and parental consent agreement (“AGREEMENT”)

In consideration of being permitted to participate in SOCCER – DODGEBALL- LACROSSE- FLAG FOOTBALL – BUBBLE BALL & CONDITIONING activity (“Activity”) I, for myself, my personal representatives, assigns, heirs and next of kin:

1.    ACKNOWLEDGE, agree and represent that I understand the nature of  SOCCER – DODGEBALL- LACROSSE- FLAG FOOTBALL – BUBBLE BALL & CONDITIONING activities and that I am qualified in good health, and in proper  physical condition to participate, in such activity.  I further agree and warrant that if at any time believe conditions to be unsafe; I will immediately discontinue further participation in the Activity.

2.   FULLY UNDERSTAND that A SOCCER – DODGEBALL- LACROSSE- FLAG FOOTBALL – BUBBLE BALL & CONDITIONING Activities involve risk and dangers of serious bodily injury, including permanent disability,  paralysis and death (“RISK”): B)these risks and dangers may be caused by my own actions or  inaction’s, the actions or inaction’s of other participating in the Activity, the condition which the Activity takes place, or  THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW C)there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILTY FOR LOSSES, COSTS AND DAMAGES I incur as a result of my participation or that of the minor in the Activity.

3.   HEREBY RELEASE, DISCHARGE AND COVENT NOT TO SUE SAMBA SPORTS ARENA, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, and any sponsors, advertisers,  and if applicable, owners and lesser of premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLGED TO BE I WHOLE OR IN PART BY THE NEGLIENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESUE OPERATIONS, AND FUTHER AGREE that if, despite this  RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf make claim against any of the releases, I WILL IDEMNIFY, SAVE AND HOLD HARMLESS EACH OF  THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage,  or cost which any may incur as the result of such claim.

4.    MINOR RELEASE and I, the minor’s Parent and /or Legal guardian, understand the nature of  SOCCER – DODGEBALL- LACROSSE- FLAG FOOTBALL – BUBBLE BALL & CONDITIONING  Activities and the Minor’s experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity.  I HEREBY RELEASE, DISCHARGE AND COVENT NOT TO SUE SAMBA SPORTS ARENA, AND AGREE TO IDEMINIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES I ON THE MINOR’S  ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, AND FUTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT THE MINOR, or anyone on the MINOR’S behalf make claim against any of the releases, named above,  I WILL IDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage,  or cost which any may incur as the result of such claim.

 

Participant/Parent/Guardian Signature: ________________________DATE:__________