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Lower Shore YMCA Challenge Course Release/Indemnification of all Claims Not to Sue

 

 


Lower Shore YMCA Challenge Course RELEASE/INDEMNIFICATION OF ALL CLAIMS AND COVENANT NOT TO SUE

 

Notice: This is a legally binding agreement. By signing this agreement, you give up your right to bring a court action to recover

compensation or obtain any other remedy for any injury to yourself or your property or for your death however caused arising out of

your use of the Alpine Tower, Giant Swing, Zip Line, Wet Willy Slide, Blob, And ALL Pond Activities(including but not limited to;

kayaking, canoing, trampoline and swiming)/ now or at anytime in the future.

NOTE 

the Alpine Tower, Giant Swing, Zip Line, Wet Willy Slide, Blob, And ALL Pond Activities(including but not limited to; 

kayaking, canoing, trampoline and swiming) will hereinafter be refered to as the Challenge Course.

 

ACKNOWLEDGEMENT OF RISK

I HEREBY ACKNOWLEDGE AND AGREE that the Challenge Course and the use of the Challenge Course  has

inherent risks. I have full knowledge of the nature and the extent of all the risks associated with the Challenge Course  and

the use of the Challenge Course, including but not limited to:

 

1. All manner of injury, including death resulting in/from falling off the Challenge Course and hitting structure and projections,

whether permanently or temporarily in place, or on the ground, or the ground;

2. Rope abrasion, entanglement and other injuries resulting from activities on or near the Challenge Course such as, but not limited to, climbing, belaying, rappelling, lowering on rope, rescue systems, and any other rope techniques;

3. Injuries resulting from falling climbers or dropped items; such as, but not limited to, ropes or climbing hardware;

4. Cuts and abrasions resulting from skin contact with the Challenge Course;

5. Failure of rope, slings, harnesses, climbing hardware, anchor points or any part of the Challenge Course structure.

 

I further acknowledge that the above list is not inclusive of all possible risks associated with the use of the Challenge Course and that

the above list in no way limits the extent or reach of this release and covenant not to sue.

 

I voluntairily agree to assume all risks of personal injury, including paralysis and death, while participating in any event, program, birthday party or training at any time, whether or not under supervision of YMCA personnel.

 

I agree to pay attention to the state of the ropes, achors and other equipment I may use, and to advise staff members if I do any damge or notice damage or problems

 

Lower Shore Family YMCA                                                                                            

A Branch of the YMCA of the Chesapeake

1900 Worcester Hwy, Pocomoke City Md, 21851

410.957.9622 www.ymcachesapeake.org

 

RELEASE / INDEMNIFICATION AND COVENANT NOT TO SUE

In consideration of  my use of the the Challenge Course, I the undersigned user, agree to release and on behalf of myself, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE the YMCA, its officers, agents, and employees from any cause of action, claim, or demand of any nature whatsoever, including but not limited to, a claim of NEGLIGENCE, which I, my heirs, representatives, executors, administrators and assigns may now have, or have in the future against YMCA on account of personal injury, mental anguish, property damage, death or accident of any kind, arising out of or in any way related to my use of the Challenge Course. whether that use is supervised or unsupervised, however the injury or damage is caused, including or not limited to the NEGLIGENCE of the YMCA its officers, agents and employees.

 

In consideration of my use of the Challenge Course, I, the undersigned user, agree to IDEMNIFY AND HOLD HARMLESS theYMCA, its officers, agents and employees, from any and all causes of action, claims, demands, losses and/or costs of any nature whatever arising out of or in any way related to my use of the Challenge Course.

 

By participating in the YMCA Nationwide Membership Program, I agree to release the National Council of Young Men’s Christian Associations of the United States of America, and its independent and autonomous member associations in the United States and Puerto Rico, from claims of negligence for bodily injury or death in connection with the use of YMCA facilities, and from any liability for other claims, including loss of property, to the fullest extent of the law.

 

I hereby certify that I have full knowledge of the nature and extent of the risks inherent in the use of the Challenge Course and that I am voluntarily assuming the risks. I understand that I will be solely responsible for any loss or damage, including death, I sustain while using the Challenge Course and that by this agreement, I release the YMCA of any and all liability for such loss, damage, or death.

 

I further certify that I am in good health and that I have no physical limitation, which would preclude my safe use of the Challenge Course.

 

I further certify that I am therefore of lawful age (18 years or older) and otherwise legally competent to sign this agreement. I further understand that the terms of this agreement are legally binding and I certify that I am signing this agreement, after having carefully read it, of my own free will.

 

Lower Shore Family YMCA                                                                                            

A Branch of the YMCA of the Chesapeake

1900 Worcester Hwy, Pocomoke City Md, 21851

410.957.9622 www.ymcachesapeake.org

 

I received a copy of the Lower Shore YMCA Challenge Course Safety Policies                                                                                            

A Branch of the YMCA of the Chesapeake

1900 Worcester Hwy, Pocomoke City Md, 21851

410.957.9622 www.ymcachesapeake.org

 

Contract to Follow Challenge Course Safety Policies

I accept full responsibility for my own safety and the safety of other climbers in the Challenge Course area. I agree to abide by and help to enforce, the following safety policies:

Safe, Smart, Together.

 Safe

Be familiar with and are responsible for following all Challenge Course rules. 

Please remove all Jewelry, bracelets, watches, necklaces, hoop earrings, and rings, sharp objects,  pull back or put up long hair

No open toed shoes are to be worn on the Challenge Course.  Shoes must be secured to participants feet

Participants will not intentionally rock or sway structure, either by jumping or rocking the structure while in it or by using guy cables

Helmets WILL be worn by all staff and participants whenever underneath the Alpine Tower and it is in use.

Staff and participants will not climb or use any structure without proper equipment (e.g., belay, helmet, harness)

Staff and participants will not have gum, candy or other objects in the mouth while participating in any Challenge Course program

Do not wrap rope around structure  or outside elemnts of the Challenge Course

NO Horseplay

 Smart

Participate at your Level

Challenge By Choice.  Never impose your expectations on someone else.

Communication between climber and belayer is extremely important.

Belayer is focused on climber

 Together

Routinely ask for safety check of your gear BEFORE EACH CLIMB/ZIP/SWING. (Helmet, harness, knots, carabineers, and rope)

Use climbing commands to communicate.

Have fun

Be open to learning. 

Inform other climbers of any sistuation seen as unsafe or not in accordance with the Challenge Course Safety Policies. All participants are asked to assist and encourage less experienced participants.

All accidents or equipment damage must be reported immediately.

 

The YMCA reserves the right to withdraw the membership of any individual permanently or for a specified period of time for breach of contract in following the Challenge Course Safety Policies, or for any conduct that is viewed as unsafe or inappropriate.

 

In consideration of the use of the Challenge Course, I acknowledge that I have read and agree to abide by the Challenge Course Safety Policies.

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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