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FEARLESS CHIX, LLC
Waiver and Release of Liability (
REQUIRED FOR EACH EVENT)

PLEASE READ THIS DOCUMENT BEFORE SIGNING. 

I, hereby consent to participate in a program of travel and related activities sponsored by Fearless Chix, LLC (the “Trip”). I understand that there are certain risks of accident and/or injury inherent in the Trip and hereby agree to assume these risks. I acknowledge and fully understand that I will be engaging in travel and activities that involve risk of injury which might result not only from my actions, but also from the actions or inactions or negligence of others. I recognize that there may be risks not known to me and/or not reasonably foreseeable.

 

I am familiar with the travel itinerary as well as the types of activities that I may participate in. I hereby certify that I am fully capable of participating in the travel and activities and, further, affirm that I have no physical or mental disabilities, allergies or infirmities that would restrict or preclude my participation in such activities. I further certify that I have had adequate time and opportunity to check with my own health care provider(s) to confirm that I may safely participate in such travel and activities. 

 

 

I understand and agree that Fearless Chix, LLC does not provide insurance to cover medical expenses for injuries that may be sustained by me or for damage to my personal property and that I have been advised by Fearless Chix, LLC to obtain my own health, medical and property insurance for purposes of potential losses related to this Trip. I have reviewed applicable current travel advisories issued by the U.S. Department of State and the Center for Disease Control relating to the Trip.

 
 

I give my permission for Fearless Chix, LLC to use my name, likeness, image, voice, and/or appearance as such may be embodied or modified in any pictures, photos, video recordings, audiotapes, digital images, any future media, and the like (“Materials”), taken or made on behalf of Fearless Chix, LLC during the Trip. I agree that Fearless Chix, LLC has complete ownership of the Materials including the entire copyright, and may alter them or use them in perpetuity worldwide in any medium or format now existing or created in the future for any purpose. I acknowledge that I will not receive any compensation for the use of such Materials. 

 
 

I understand that my participation in the Trip is entirely voluntary and at my own risk and that Fearless Chix, LLC is not responsible for my safety. I fully understand the scope of the activities and the potential risks involved in the Trip. I agree to assume the risks of my participation in the Trip including, but not limited to, the risk of serious injury or death. I release, discharge, waive and covenant not to sue Fearless Chix, LLC, and all of its respective members, agents, affiliates, associates, officers and employees (collectively “Releasees”) from demands, losses or damages on account of any injury, death or damage to person or property caused, or alleged to be caused, in whole or in part, by Releasees or any other party’s actions, inactions, or otherwise, and agree to indemnify Releasees from any and all third party claims caused in whole or in part by my actions. 

 

I agree to indemnify, defend and hold harmless Fearless Chix, LLC for any and all losses, expenses, claims, judgments and liabilities (including attorney fees) of any nature arising out of, or in consequence of, my acts, words, conduct, etc. in connection with the Trip including, but not limited to, damage to property, any injuries or death sustained by any person(s) as a result of my actions. 

 

I/We have carefully read this Waiver and Release and understand that it contains, among other things, a release of liability of Fearless Chix, LLC, and its members, affiliates, successors, associates, employees and assigns and constitutes a legally binding contract between me and Fearless Chix, LLC. Any provisions found to be void or unenforceable shall not affect the validity or enforceability of any other provisions. This agreement shall be construed and enforced in accordance with the laws of the State of Maryland. My signature below is of my own free will and I agree to all stated conditions, releases, and limitations of liability.

Dated: October 30, 2020 

 

First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle 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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

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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