Loading...

Activities and Programs - Waiver and Release Of Liability

I, the undersigned Participant, in consideration of being allowed to participate in athletic, sports, recreational and/or fitness programs, activities and other events at Mid-Coast Recreation Center, Inc., a Maine non-profit corporation (hereinafter referred to as "MRC"), do hereby acknowledge, appreciate and agree that:

  1. There are inherent risks of injury when participating in rink and other sports, recreation and fitness activities and programs at MRC, which risks are significant, including the potential for permanent or serious injury. These risks include, but are not necessarily limited to, cuts, bruises, muscular sprains, strains and tears, closed and open head injuries or trauma, concussions, dislocation of joints, broken bones, paralysis, and even death. There is also risk from being hit, tripped or otherwise injured by a puck, ball, stick, racquet or another participant and from impact or contact with hard surfaces, nets, curtains, weights, and loose balls, pucks or other objects. While rules, equipment and personal discipline and good judgment may reduce some of these risks, the risk of permanent or serious injury cannot reasonably be eliminated and does inherently exist.
     
  2. When participating in any ice hockey program, event or activity, I understand that wearing full hockey gear is required if sticks or pucks are used on the ice. Full hockey gear includes, but is not necessarily limited to, shin guards, jock strap and cup (for men/boys), hockey pants, elbow and shoulder pads, gloves, helmet, face guard/shield and mouthguard. For non-ice hockey programs, I understand that MRC strongly encourages participants to wear appropriate protective equipment to avoid injury when skating. I further understand that MRC, its board of directors, officers, employees, independent contractors, referees, officials, and other agents (hereinafter referred to as “Releasees”), shall not be responsible to monitor or ensure that I am wearing any required or recommended protective gear and that this responsibility rests solely with me.
     
  3. I understand that “off-ice” programs are hosted on the hard, unforgiving concrete rink surface. Proper safety equipment, including a helmet, is required for most, if not all, programs. I further understand that Releasees shall not be responsible to monitor or ensure that I am wearing appropriate protective gear and that this responsibility rests solely with me.
     
  4. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the Releasees or others, and assume full responsibility for my participation. 
     
  5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, hold harmless and indemnify Releasees with respect to any and all injury, disability, death, loss or damage to person or property, whether arising from the negligence of Releasees or otherwise.
     
  6. I further authorize MRC to call for emergency medical care for me and/or to transport me to a medical facility or hospital if it appears to MRC that I require immediate medical attention. I further authorize appropriate personnel to render emergency medical treatment to me if necessary.
     

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Date: November 22, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
MRC may use photography/videography for promotional purposes:*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
MRC may use photography/videography for promotional purposes:*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
MRC may use photography/videography for promotional purposes:*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
MRC may use photography/videography for promotional purposes:*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
MRC may use photography/videography for promotional purposes:*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
MRC may use photography/videography for promotional purposes:*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
MRC may use photography/videography for promotional purposes:*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
MRC may use photography/videography for promotional purposes:*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
MRC may use photography/videography for promotional purposes:*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
MRC may use photography/videography for promotional purposes:*
Participant's 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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact:

Emergency Contact Name: *

Relationship: *
Emergency contact is the parent/guardian listed below.

Cell Phone: *
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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
MRC may use photography/videography for promotional purposes:*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver