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The "Release and Hold Harmless Agreement" must be signed prior to participatinng in the "Live for 175" Event.

Release and Hold Harmless Agreement

I, the undersigned participant, request voluntary participation for myself to participate in the Live for 175 activity which begins at 11:00:00 am on Saturday April 14th, 2018, and ends no later than 7:00 pm Saturday April 21st, 2018 sponsored by Townsquare Media and The Village at Meridian all of which are hereinafter referred to as the “activity”.

I consent to participation in the activity and acknowledge that I fully understand my participation may involve risk of serious injury or death, including losses which may result not from my own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the event or activity is being conducted, and/or the rules of play of this type of event or activity.  I understand that if I have any risk concerns, I should discuss the risks associated with my participation with the activity coordinators and event staff before I sign this document and before the activity begins.

I certify that I am in good health and have no physical condition that would prevent participation in this activity.   Furthermore, I agree to use my personal medical insurance as a primary medical coverage payment if accident or injury occurs.  I consent to emergency medical treatment in the event such care is required.

I agree that photographs, pictures, slides, movies, video, or other media coverage of me may be taken in connection with my participation in the activity without compensation from Live for 175 entities, Townsquare Media Boise, LLC, and the officers, directors, employees and agents of either of them and consent to the use of photographs, pictures, slides, movies, videos, or other media coverage for any legal purpose.

Knowing and understanding the risks involved with participation in the activity, I hereby voluntarily and willingly assume responsibility for all risks and dangers associated with my participation in the activity.  I agree I am financially responsible for any losses resulting from my actions and will indemnify Live for 175 entities, Townsquare Media Boise, LLC, sponsors, partners, and the officers, directors, employees and agents of all of them, for any loss or damage caused by myself during this activity.

In consideration of my participation in the activity, I hereby waive all claims or causes of action against Live for 175  entities, Townsquare Media Boise, LLC, sponsors, partners and the officers, directors, employees and agents of all of them,  arising out of my participation in the activity and hereby release, hold harmless, and discharge Live for 175 entities, Townsquare Media Boise, LLC, sponsors, partners, and the officers, directors, employees and agents of all of them from all liability in connection therewith.

I have read this release and hold harmless agreement and understand the terms used in it and their legal significance.  This waiver and release is freely and voluntarily given with the understanding that right to legal recourse against Live for 175 entities, Townsquare Media Boise, LLC, sponsors, partners, and the officers, directors, employees and agents of all of them is knowingly given up in return for allowing my participation in the activity.  My signature on this document is intended to bind not only myself but also my successors, heirs, representatives, administrators, and assigns.

First Rider Name

First Name*

Middle Name

Last Name*

Phone*
First Rider Date of Birth*
First Rider Signature*
Second Rider Name

First Name*

Middle Name

Last Name*
Second Rider Date of Birth*
Second Rider Signature*
Third Rider Name

First Name*

Middle Name

Last Name*
Third Rider Date of Birth*
Third Rider Signature*
Fourth Rider Name

First Name*

Middle Name

Last Name*
Fourth Rider Date of Birth*
Fourth Rider Signature*
Fifth Rider Name

First Name*

Middle Name

Last Name*
Fifth Rider Date of Birth*
Fifth Rider Signature*
Sixth Rider Name

First Name*

Middle Name

Last Name*
Sixth Rider Date of Birth*
Sixth Rider Signature*
Seventh Rider Name

First Name*

Middle Name

Last Name*
Seventh Rider Date of Birth*
Seventh Rider Signature*
Eighth Rider Name

First Name*

Middle Name

Last Name*
Eighth Rider Date of Birth*
Eighth Rider Signature*
Ninth Rider Name

First Name*

Middle Name

Last Name*
Ninth Rider Date of Birth*
Ninth Rider Signature*
Tenth Rider Name

First Name*

Middle Name

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

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Have you "Tapped Dat App"?
103.5 KISS FM Mobile App from iTunes and Google Play*
Yes
No
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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