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WAIVER OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

UNITED STATES MARINE CORPS

Aquatics programs

In consideration for the privilege of allowing me and/or my minor child to participate in an organized event aboard Marine Corps Base Camp Lejeune and/or Marine Corps Air Station New River, North Carolina, I, the undersigned person, intending to be legally bound and recognizing the voluntary nature of my participation, hereby agree to and promise the following:

 

1. I have full knowledge of and understand the risks associated with participating in this event. I understand that there is a risk of loss or damage to my property. I understand that there is a risk of serious injury, permanent disability and even death. I understand that participation in an activity aboard a military installation carries with it certain inherent risks and dangers in addition to those inherent to the activity in which I (or my minor child) intend to participate. I accept full responsibility for the total costs of any damage to my property or for any medical treatment required for any injury I (or my minor child) may sustain. I understand that, should I decline to execute this agreement, neither I nor my minor child will be permitted to participate in this event.

 

2. With these dangers in mind, I fully and voluntarily assume the risks involved in my presence aboard Marine Corps Base Camp Lejeune/MCAS New River  and the risks involved in my (or my minor childs) participation in the activity stated above. In doing so, I understand that I am waiving on behalf of myself and all of my guardians, executors, administrators, legal representatives, successors, heirs or assigns all rights and claims for damages, demands, and any other actions stemming from any loss, damage or injury to my (or my minor childs) person or property that may arise from my (or my minor childs) participation or presence aboard Marine Corps Base Camp Lejeune/MCAS New River. I agree to release from liability and hold harmless the United States Government and all of its agencies and departments, to include (but not limited to) the Department of Defense and the Department of the Navy. I also agree to release from liability and hold harmless the United States Marine Corps and all subordinate units and commands thereof, to include (but not limited to) U.S. Marine Forces Command; Marine Corps Installations East; Marine Corps Base Camp Lejeune; Marine Corps Air Station New River; Marine Corps Community Services; Second Marine Expeditionary Force; Second Marine Division; Second Marine Logistics Group; and Semper Fit. Finally, I agree to release from liability and hold harmless all commanders, officers, supervisors, military service members, employees and other agents of the United States Government or any subdivision thereof, and promise not to prosecute any of the aforementioned persons or their agents or representatives, successors or assigns in either their official or personal capacities.

 

3. I also understand and agree that I may be held liable for any damage, injury or loss to the United States Government that is caused by my own negligence, willful misconduct or fraud. Furthermore, I understand and agree that I may be held liable for any damage, injury or loss to any third party that is caused by my own negligence, willful misconduct or fraud. Finally, I promise to indemnify the United States Government and any of its agents or assigns for any cause of action arising out of my negligence, willful misconduct or fraud while aboard Marine Corps Base Camp Lejeune/MCAS New River or while participating in this event.

 

4. [If participant is a minor, a parent or legal guardian must sign!] I, as the parent or legal guardian of the undersigned minor participant, hereby agree to indemnify the United States Government and all of its agencies, departments and employees against any and all liability, claims, suits, losses, costs, and legal fees caused by, arising out of, or resulting from either the minors participation in the event, the minors presence aboard Marine Corps Base Camp Lejeune/MCAS New River, or any negligent act by the minor while participating in the organized event aboard base.

January 22, 2019

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First Participant's Name

First Name*

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

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone 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. Signing for a minor other than your own is a fraudulent misrepresentation and a Federal crime
Parent or Guardian's Name

First Name*

Last Name*
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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