G Intensity Pole Vault Club Waiver Form
In consideration of __________________________ my minor child/ward (“my child”), being allowed to participate in any way in the G intensity Pole Vault Club program, Stephen Guziewski, and, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and , FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and, I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and /or in the program itself, I will removed my child from the participation and bring such attention of the nearest official immediately; and, I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“’Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs. EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. I do hereby release and forever discharge Stephen Guziewski, the Madison Metropolitan School District, and its employees and representatives from any and all claims, demands, actions, causes of action, judgments, expenses, injuries to person(s) or property sustained or incurred in connection with , or as a result of my participation in the G Intensity pole vault club. I agree to hold Stephen Guziewski, the Madison Metropolitan School District wholly harmless for any and all liability, loss, expense or damage it may incur by virtue of allowing me to participate in the G intensity pole vault club, to use its facilities or to participate in its activities or programs. I also agree to allow G Intensity Pole Vault Club to obtain reasonable emergency medical care and treatment in the unlikely event that such medical care and treatment becomes necessary.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP STUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
__________________________________________ ___________________________________
(Parent /Guardian Signature) (Print Name)
Date Signed ___________________________
UNDERSTANDING OF RISK
I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant.
__________________________________________ ___________________________________
(Participant Signature) (Print Name)
Date Signed ___________________________
For easy printing of this waiver: highlight the document and from print menu click on "Selection"'.
After printing please sign waiver and mail with check to:GI Vault Club 1121 Lorraine Drive Madison,WI 53705
