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Route 1 Hockey Waiver for off and on ice programs.

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT - ROUTE 1 HOCKEY LLC

In consideration of participating in training activities, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence Route 1 Hockey LLC and its owners, directors, officers, employees, agents, volunteers, participants, and all other persons or entities acting for them, as well as the owner of the subject premises, Mark Vissers (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows:

1. I acknowledge that training activities involve known, inherent, as well as unanticipated risks which could result in physical or emotional injury, spinal damage, paralysis or permanent disability, stroke, heart attack, even death, and property damage. Risks include, but are not limited to broken bones, seizures, concussion, bruises and other bodily injuries caused by but not limited to judgment or behavior related problems by the participant or other participant, falls, contact or collision with other participants, objects, obstacles or equipment; medical conditions resulting from physical activity and/or a stressful environment, such as a loud noise or flashing lights; inadequate or negligent first aid and/or emergency measures; damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity.

2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation. I also understand that is my responsibility to consult with my personal physician prior to participating to ensure that my participating will not pose any unusual risks to my health and wellbeing.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition, which could interfere with my safety in this activity, or else I am willing to assume – and bear the costs of – all risks that may be created, directly or indirectly, by any such condition.

5. I agree that all disputes, controversies or claims arising out of my participation in Route 1 Hockey LLC services shall be submitted to binding arbitration in accordance with the applicable rules of the American Arbitration Association then in effect. The cost of such action shall be shared equally by the parties. In the event that I nonetheless file a lawsuit despite my agreement, I agree to do so solely in Brown County, Wisconsin where Releasees’ facility is located, and I further agree that the substantive law of Wisconsin shall apply.

6. I agree to follow the safety rules and good conduct as explained to me in the safety briefing. In the event of violations of these rules or conduct, I understand my gym experience may be suspended or terminated. No refund will be provided to me in event of such action.

7. I further grant to Route 1 Hockey LLC, its representatives and employees the right to take photographs of me and my property in connection with my participation in Route 1 Hockey LLC services,  including but not limited to: classes, parties, private lessons, open gym, etc. I authorize Route 1 Hockey LLC, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

8. I agree that Route 1 Hockey LLC may use such photographs and images of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.

9. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

10. I understand fully the inherent risks involved in participating in training activities and assert that I am willingly and voluntarily participating in same. I have read the preceding paragraphs and acknowledge that I know the nature of participating, I understand the demand of this physical activity relative to my physical condition, and I appreciate the potential impact of the types of injuries that may result from participating.

By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.

I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain.

COVID-19: I acknowledge the contagious nature of the COVID-19 and further acknowledge that Route 1 Hockey LLC can not guarantee that my child will not become infected with COVID-19. By voluntarily attending classes at Route 1 Hockey, I may be increasing my child’s risk to exposure to COVID-19. I acknowledge that we must comply with all set procedures to reduce the spread while attending training sessions and that:  1. My child is not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.  2. I do not believe our family has been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. 3. My child has not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities. 

I hereby release and agree to hold Route 1 Hockey LLC harmless from, and waive on behalf of myself, my child, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act, that may otherwise arise in any way in connection with any training at Route 1 Hockey LLC or by Route 1 Hockey staff. I understand that this release discharges Route 1 Hockey LLC from any liability or claim that I, my child, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any training at Route 1 Hockey or by Route 1 Hockey staff. This liability waiver and release extends to Route 1 owners and employees.

First Player Name

First Name*

Last Name*

Phone*
First Player Age Acknowledgment*
First Player Date of Birth*
I certify that I am 18 years of age or older
First Player Signature*
Second Player Name

First Name*

Last Name*
Second Player Date of Birth*
Third Player Name

First Name*

Last Name*
Third Player Date of Birth*
Fourth Player Name

First Name*

Last Name*
Fourth Player Date of Birth*
Fifth Player Name

First Name*

Last Name*
Fifth Player Date of Birth*
Sixth Player Name

First Name*

Last Name*
Sixth Player Date of Birth*
Seventh Player Name

First Name*

Last Name*
Seventh Player Date of Birth*
Eighth Player Name

First Name*

Last Name*
Eighth Player Date of Birth*
Ninth Player Name

First Name*

Last Name*
Ninth Player Date of Birth*
Tenth Player Name

First Name*

Last Name*
Tenth Player Date of Birth*
Player Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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