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BLALOCK LAKES CLUB

IRREVOCABLE WAIVER AND RELEASE 

The undersigned, for and on behalf of himself or herself, and for and on behalf any of his or her minor children who participate or are otherwise involved in or exposed to the activities hereinafter described, hereby acknowledges and represents that he or she is voluntarily participating in activities of and at the Blalock Lakes Club, Inc., a Georgia nonprofit corporation (“Club”), including, without limitation, biking, hiking, fishing and hunting, shooting and other activities involving the discharge of firearms; that to the extent any minor children are involved with the undersigned, the undersigned is the parent or legal guardian of, or that he or she otherwise has or maintains supervisory control over, such minor child or children and hereby acknowledges his or her express consent for such child or children to participate in the activities of the Club; that the undersigned has read and agrees to strictly abide by the rules and procedures of the Club; that the undersigned is aware of and acknowledges that hunting, shooting, biking, hiking, fishing and other activities carried out at the Club are inherently dangerous, but expressly hereby agrees to assume all risks of personal injury, including death, and loss or damage to property resulting from the use and enjoyment of any facilities, property and/or activities operated, maintained, or carried on by the Club. The undersigned hereby further agrees that neither the Club, FGM Blalock Investments LLC, a Georgia limited liability company, FGM Blalock Development, LLC, a Georgia limited liability company, Blalock Lakes Property Owners Association, Inc., a Georgia  nonprofit corporation, BlackHawk Lakes, LLC, a Georgia limited liability company, nor any shareholder, partner, member, director, officer, employee or agent of any of the foregoing named entities, nor any other entity affiliated with or related to any of the foregoing parties (hereinafter referred to collectively as the “Released Parties”), makes any express or implied warranties or representations or statements, whether written or oral, regarding the safety, conditions or other aspects of the property and activities carried out by the Club within the Club property or any property adjacent thereto.

The undersigned further hereby for himself or herself and any minor children participating in Club activities: (1) accepts full and total responsibility for and expressly assumes all risk with respect to any and all personal injury, including death, and loss or damage to property which may be suffered or incurred as a result of the activities described above; (2) releases the Released Parties from any and all obligations to monitor or supervise the activities of the undersigned and any minor children in connection with the use of Club facilities other than by away of enforcement of the rules and procedures of the Club; and (3) hereby expressly and irrevocably waives, releases, indemnifies and holds harmless the Released Parties from any and all claims, actions, causes of action, suits, proceedings, damages and liabilities, including, without limitation, indirect, special, or consequential loss or damage arising from personal injury, destruction of property, trespass, loss of enjoyment, or any other wrong or entitlement to remedy based upon, due to, arising from, or otherwise relating to the use of any facilities of the Club or participation in any activities of the Club.

The undersigned hereby gives the Club the absolute right and permission to copyright and/or publish, or use photographic and/or video portraits or pictures of me, or in which the undersigned or his or her minor children participating in Club activities may be included in whole or in part, or composite or distorted in character of form, in conjunction with my own or fictitious name, or reproductions thereof in color or otherwise, made through any media for art, advertising, trade or any other lawful purpose whatsoever. The undersigned hereby waives any right that the undersigned or his or her minor children participating in Club activities may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith, or the use to which it may be applied. The undersigned further hereby for himself or herself and any minor children participating in Club activities releases, discharges, and agrees to save the Club from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said pictures and/or video, or in any processing lending towards the completion of the finished product.

The undersigned expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Georgia and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

The undersigned hereby confirms that he/she has knowingly and voluntarily executed this Waiver and Release and has read and agrees to abide by the rules and procedures set forth on the reverse side hereof this

______ day of _______________________, 202__.

 

 

First Participants Name

First Name*

Last Name*

Phone*
First Participants Age Acknowledgment*
First Participants Date of Birth*
I certify that I am 18 years of age or older
First Participants Information
Member or Guest:*

Name of Spouse:
First Participants Signature*
Second Participants Name

First Name*

Last Name*
Second Participants Date of Birth*
Second Participants Information
Member or Guest:*

Name of Spouse:
Third Participants Name

First Name*

Last Name*
Third Participants Date of Birth*
Third Participants Information
Member or Guest:*

Name of Spouse:
Fourth Participants Name

First Name*

Last Name*
Fourth Participants Date of Birth*
Fourth Participants Information
Member or Guest:*

Name of Spouse:
Fifth Participants Name

First Name*

Last Name*
Fifth Participants Date of Birth*
Fifth Participants Information
Member or Guest:*

Name of Spouse:
Sixth Participants Name

First Name*

Last Name*
Sixth Participants Date of Birth*
Sixth Participants Information
Member or Guest:*

Name of Spouse:
Seventh Participants Name

First Name*

Last Name*
Seventh Participants Date of Birth*
Seventh Participants Information
Member or Guest:*

Name of Spouse:
Eighth Participants Name

First Name*

Last Name*
Eighth Participants Date of Birth*
Eighth Participants Information
Member or Guest:*

Name of Spouse:
Ninth Participants Name

First Name*

Last Name*
Ninth Participants Date of Birth*
Ninth Participants Information
Member or Guest:*

Name of Spouse:
Tenth Participants Name

First Name*

Last Name*
Tenth Participants Date of Birth*
Tenth Participants Information
Member or Guest:*

Name of Spouse:
Participants 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*
A signed copy of this waiver will be sent to the email address you provide.
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*

Relationship*

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 Information
Member or Guest:*

Name of Spouse:
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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