Autism Support And Resource Center
WAIVER AND RELEASE OF LIABILITY AND
ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
In consideration of being permitted to participate in Autism Support Group of Genesee County (ASGGC) activities in any capacity, I, for myself and for my heirs, next of kin, assigns and personal representatives:
Understand that my execution of this Waiver is a prerequisite for my participation and/or the participation of my child(ren) or ward of whom I am the parent or guardian (“my child”), in the Event.
Understand that I am solely responsible for the health and safety of myself and/or my child, and represent that I and/or my child is in good health and physically capable of participating in this Event. If at any time during my and/or my child’s participation in the Event I feel like my and/or my child’s physical condition no longer allows me and/or my child to participate or I believe the Event becomes unsafe, I will immediately stop my and/or my child’s participation. I will abide by all Event rules and will be responsible for ensuring that my child will do so.
Acknowledge and understand fully that there are risks and dangers of serious bodily injury and death that could result from my and/or my child’s participation in the Event. I understand that in order to be allowed to participate in the Event, I agree to fully accept and assume all risks and all responsibility for any injury, losses and damages to person or property that I and/or my child may incur as a result of my and/or my child’s participation in the Event.
Hereby agree to release and hold harmless the Autism Support Group of Genesee County, the owner or possesor of the venue, and their past and present affiliates, assigns, successors in interest, agents, servants, employees, volunteers, participants, officers, directors and sponsors, and all government and public entities including, but not limited to, the State, County and local municipalities where the Event takes place (collectively the “Released Parties”).
Understand and agree that this release will have the effect of releasing, discharging, waiving, and forever relinquishing any and all actions or causes of action that I and/or my child may have, whether past, present or future, whether known or unknown, arising from, resulting from, or in connection to the Event. This release constitutes a complete release, discharge and waiver of any and all actions or causes of action that I and/or my child may have against the Released Parties, including but not limited to any claims for personal injury, property damage, or wrongful death and including but not limited to any injuries resulting from negligent actions or omissions.
Irrevocably authorize the Autism Support Group of Genesee County to use my and/or my child’s recorded voice, image and likeness in any medium including, without limitation, video, photograph, film, tape, and digital medium, for any lawful purpose. I understand that neither I nor my child will receive any compensation for the use of my and/or my child’s recorded voice, image and likeness in promotional materials and waive rights to any compensation now or in the future.
Have carefully read this Waiver and fully understand its contents. I am aware that this is a release of liability and I sign of my own free will. I intend this to be a complete and unconditional release of all liability to the greatest extent allowed by the law, even though that liability may arise from the negligence or carelessness of the Released Parties listed above, and I agree that if any portion of this agreement is held to be invalid, the remaining portion of the agreement shall continue to be in full force and effect.
I certify that the information contained in this application is true and correct. I understand that false information may be grounds for not using me as a volunteer at any point in the future. I authorize the verification of any or all information listed above.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.