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Guest Visit Waiver

WAIVER OF LIABILITY
I agree to the Assumption of Risk, Release, and Waiver of Liability, Indemnity and Arbitration Agreement and Publicity Release that is printed on the back of this form.

Assumption of Risk, Release and Waiver of Liability; Indemnity & Arbitration

On behalf of myself and my minor children and guests if any (collectively, the “User”), I acknowledge that, prior to engaging in any activity in or about Jewish Silicon Valley, a nonprofit corporation (“JSV”), Levy Family Campus, a nonprofit corporation (“LFC”), and Addison-Penzak Jewish Community Center (“JCC”) or sponsored by JSV, LFC, or JCC, the User has been advised to consult with and receive the approval of a physician.

User knows, understands, and appreciates the risks of entry upon and/or use of JSV, LFC, or JCC property, fitness facilities and/or equipment, including but not limited to loss of or damage to personal property, serious or catastrophic personal injuries and/or death.

User confirms that he/she is voluntarily participating in JSV, LFC, and JCC’s activities, and/or entering upon and/or using JSV, LFC, and JCC’s property, facilities and/or equipment, and User hereby assumes all risk that he/she may suffer personal, bodily or mental injury and/or death, economic loss and/or damage as a result of his/her entry upon and/or use of JSV, LFC, and JCC’s property, facilities and/or equipment and/or participation in JSV, LFC, and JCC activities. User acknowledges and agrees that he/she is solely responsible for his/her safe and responsible entry upon and/or use of JSV, LFC, and JCC property, facilities and equipment, whether or not supervised by a JSV, LFC, and JCC representative.

In consideration for being permitted to enter upon and/or use the JSV, LFC, and JCC’s property, facilities and/or equipment and/or participate in JSV, LFC, and JCC activities, on behalf of him/herself and his/her spouse, unborn children, heirs, representatives, guardians, distributees, successors and assigns (the “User Parties”), User Parties hereby release and discharge the JSV, LFC, and JCC, each of their contractors and all of the trustees, members, officers, employees, agents and assigns of the foregoing, including their affiliated organizations (the “JSV Parties”) from any and all claims, causes of action or liability for any damages to and/or loss of property, injuries and/or death User may suffer in or about, resulting from User’s participation in JSV, LFC, and JCC activities, entry upon and/or use of JSV, LFC, and JCC’s property, facilities and/or equipment, whether or not the same arises out of or results from any act, omission and/or conduct of any of the JSV Parties, negligent or otherwise.

In addition, User agrees to hold harmless, indemnify and defend the JSV Parties from all claims, demands, causes of action or liability for any loss, damage, and/or injury to persons or property arising from or relating to User’s entry upon and/or use of JSV, LFC, and JCC’s property, facilities, and/or equipment and/or participation in JSV, LFC, and JCC activities, including without limitation attorney’s and expert’s fees, expenses, costs and all consequential damages, whether or not resulting from any act, omission or conduct of any of the JSV Parties.

USER ACKNOWLEDGES THAT HE/SHE HAS CAREFULLY READ THIS AGREEMENT AND IS AWARE THAT IT CONTAINS A WAIVER AND RELEASE OF LIABILITY AND THAT USER IS GIVING UP SUBSTANTIAL RIGHTS, INCLUDING HIS/HER RIGHT TO SUE. USER IS SIGNING THIS AGREEMENT OF HIS/HER OWN FREE WILL AND INTENDS FOR HIS/HER SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST
EXTENT ALLOWED BY LAW.

PR Disclosure: I give unconditional permission to the JSV, LFC, and JCC to photograph or film me and/or my children, and to use the photographs or videos to publicize the JSV, LFC, and JCC and its programs and activities in publications, advertisements, web sites or news articles pertaining to the JSV, LFC, and JCC without compensation of any kind.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
What are your fitness interests? (You may click more than one)
Basketball
Group Fitness Classes
Massage/Hydrafacial
Nutrition Coaching
Personal Training
Pickleball
Pool
Swim Lessons
Tennis
Other
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*

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 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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