SAMBA SOCCER - RENTAL FORM

 

YOUR SIGNATURE INDICATES THAT YOU HAVE READ AND UNDERSTANDING THE FOLLOWING.

RENTAL TIME = SAMBA SOCCER FACILITY (whole building – Field & seating area).

Rental fee includes setup & cleanup in your allocated rental time slot. 

If you go over your allocated time you will be charged accordingly.

All rentals require a nonrefundable deposit of $50.00 one-week before the desired date.

NAME ORGANISATION /PERSON RESPONSIBLE FOR RENTAL  _______________________________

PHONE (    ) _____________________

ADDRESS ______________________________ CITY GV/NC/AUB       ZIP _________

DATE OF RENTAL ___________TIME OF RENTAL FROM ___am/pm to _____am/pm

HOURLY RATE: $100.per hour

DEPOSIT $ ______ Received ________Cash   Credit Card Check # ­­ ­­_________

BALANCE DUE $ _______Received __________ Cash   Credit Card Check # ­­______

Be advised there maybe other Rentals @ Samba before or after your rental, so please be courteous.  Samba staff is only required to be @ Samba during allocated rental times & are NOT responsible or required to referee games.

RELEASE AND WAIVER OF LIABILTY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT (“AGREEMENT”)

In consideration of being permitted to participate in SOCCER-DODGEBALL-FLAG FOOTBALL 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-FLAG FOOTBALL 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 I believe conditions to be unsafe; I will immediately discontinue further participation in the Activity.

2.        FULLY UNDERSTAND that: a) SOCCER-DODGEBALL-FLAG FOOTBALL 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 others participating in the Activity, the condition in 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 COVENANT NOT TO SUE SAMBA SOCCER, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, and any sponsors, advertisers, and if applicable, owners and lessers of premises on which the Activity takes places, (each considered one of the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLGED TO BE 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 I, or anyone on my behalf, make a claim against any of the releasees, 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.

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY THE LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

MINOR RELEASE

AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF SOCCER-DODGEBALL-FLAG FOOTBALL 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 ACITVITY.  I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY 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 NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESUCE OPERATIONS AND FUTHER AGREE THAT IF, DESPITE THIS RELEASE, I THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.

SIGNATURE_______________________________________________ Date______ / ______ / ________