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CITY OF PORTLAND, MAINE & FRIENDS OF FORT GORGES COMBINED LIABILITY WAIVER

PLEASE READ CAREFULLY BEFORE SIGNING

City of Portland, Maine

I hereby request that I be permitted to perform or engage in certain entertainment activity at a City of Portland facility, namely that I be permitted to participate in an event being held at/on Fort Gorges in Portland, Maine (hereinafter the "Activity”). I understand that participating in this Activity involves risk of injury to all parts of my body. I understand that there are numerous risks including, but in no way limited to, uneven terrain, fall hazards, environmental conditions, the configuration of the facilities, slipping and falling, and other risks associated with this Activity, which independently or in connection with my actions or the actions of others, may cause severe or even fatal injuries to me or others. I agree that I alone am responsible for my safety while participating in this Activity. IN CONSIDERATION of being permitted to engage in the Activity, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge:

  1. I acknowledge, agree and represent that the Activity that I am going to voluntarily engage in may involve the risk of serious bodily injury and/or death and/or property damage.
     
  2. I acknowledge, agree and represent that the City of Portland, its agents, officers, and employees (collectively, the “City”), accept no responsibility and will not be liable for any injury, harm, or damage to my person or my property occurring during, or arising out of, or in connection with, the Activity.
     
  3. To the fullest extent permitted by law​, I do hereby agree to assume all risk of injury, harm, or damage to me and/or my property, and/or to the property of others in my possession (including but not limited to all risks of injury, harm or damage caused by the negligence of the City of Portland, its agents, officers or employees) arising during or in connection with the Activity. I do hereby release and agree to defend, indemnify and hold the City harmless from any and all liability, actions, damages, and claims of any kind and nature whatsoever, (including but not limited to liability, actions, damages, and claims caused by or arising from the negligence of the City) for injury, harm or damage to me and/or my property, and/or to the property of others in my possession, and/or to other persons or property in any way caused by my actions or inactions, (including but not limited to disability or death) that may arise out of, or occur during or in connection with said Activity. I do hereby promise not to sue the City of Portland, its agents, officers and employees with respect to any such claims or liabilities. This waiver and release is intended to be as broad as the law allows.

I have read the entire release, understand it, and am signing this agreement freely.

And further, I hereby give my permission for emergency medical treatment in case I am unable to consent and the contact above cannot be reached.

Friends of Fort Gorges

I, the participant, intending to be legally bound do hereby waive and forever release any and all right and claims for damages or injuries that I may have against Friends of Fort Gorges and all of their agents assisting with the event, sponsors and their representatives, volunteers and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees.

In the event of an illness, injury or medical emergency arising during the event I hereby authorize and give my consent to Friends of Fort Gorges to secure from any accredited hospital, clinic and/or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to rescue operations, medical transport, medications, treatment and hospitalization.

By signing this waiver, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above release and waiver.

Further, I grant permission to all the foregoing to use my name, voice and images of myself in any photographs, motion pictures, results, publications or any other print, videographic or electronic recording of this event for legitimate purposes.

I HAVE CAREFULLY READ THIS AGREEMENT AND AGREE TO ITS TERMS​, WHICH ARE FULLY BINDING ON ME. I AM EIGHTEEN (18) YEARS OF AGE OR OLDER, AND I FREELY AND VOLUNTARILY ENTER INTO THIS AGREEMENT.

Today's Date: October 16, 2019

First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
PARENT/GUARDIAN AUTHORIZATION FOR PARTICIPANTS UNDER 18 YEARS OF AGE As a parent/guardian with legal responsibility for this minor participating in this Activity, on behalf of whom this agreement is entered, ​I HAVE CAREFULLY READ THIS AGREEMENT AND AGREE TO ITS TERMS​. I agree that I am eighteen (18) years of age or older, and I have the authority to enter this Agreement on behalf of this minor child. I have read and explained this Agreement to this minor, and I, the minor, and anyone on behalf of this minor is bound by the terms of this Agreement. I agree to indemnify and hold harmless the City of Portland for any claim from myself, from this minor, or from anyone on behalf of this minor brought as a result of participation in this Activity.
Parent or Guardian's Name

First Name*

Last Name*

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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