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RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (“Agreement”)

In consideration of being permitted to be present at, attend, observe, and participate in activities at the facilities of, or provided by, Roseland Youth Center (the "Activities") I, for myself for and for my child(ren) (collectively referred to herein as “me” “I” or “my”), personal representatives, assigns and heirs:

  1. Acknowledge, agree, and represent that I understand the nature of the Activities and that I am qualified, in good health, and in proper physical condition to participate in them. I further agree and warrant that if at any time I believe conditions to be unsafe, or if at any time my health suffers, I will immediately discontinue participation, and leave if appropriate.
  2. Authorize Roseland Youth Center, its respective owners, investors, members, managers, shareholders, agents, directors, officers, volunteers, employees, landowners, subsidiaries, and affiliated companies (collectively, "Releasees") and medical care provider(s) to carry out any emergency medical transport or medical care for me, as may be necessary in their sole discretion, and agree to be fully responsible for any costs associated with such transport and care.
  3. Understand that it is my responsibility to comply with all posted and published procedures, including safety and hygiene procedures and protocols intended to lessen the likelihood of the spread of disease among participants and staff. I further understand that it is my responsibility to comply with all laws and other requirements imposed by federal, state, and local authorities.
  4. UNDERSTAND THAT THE ACTIVITIES INVOLVE INHERENT AND OTHER RISKS AND DANGERS, including but not limited to falling or loss of balance; striking padded or unpadded surfaces; being injured by equipment; being injured by the actions or inactions of other participants and bystanders; collisions with other participants; falls due to slick or uneven surfaces; equipment failures of any kind; equipment misuse by myself or others; potential exposure to communicable disease (including but not limited to coronavirus/COVID-19, other viruses, bacteria, and all other infectious pathogens and disease vectors); physical injury or illness as a result of physical activity or being on the premises where the Activities take place; and, which risks may result in SERIOUS INJURY, ILLNESS, EMOTIONAL DISTRESS, AND DEATH (collectively, "Risks"). I understand that the Risks may be caused or contributed to by my own actions or inactions, the actions or inactions of other participants, bystanders or staff, the conditions and settings in which the Activities take place, or the alleged or actual NEGLIGENCE of the Releasees. I understand that the description and list of Risks in this Agreement is not complete, and that I will encounter Risks not described herein, known and unknown, inherent and otherwise, in connection with the Activities. With a full understanding of the foregoing, I VOLUNTARILY AGREE TO ASSUME ALL INHERENT AND OTHER RISKS OF INJURY, ILLNESS, EMOTIONAL DISTRESS, AND DEATH AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of, or in connection with, the Activities.
  5. RELEASE, DISCHARGE, HOLD HARMLESS, AND AGREE NEVER TO SUE RELEASEES FOR ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ARISING FROM OR RELATED TO ACTIVITIES, INCLUDING INJURY, ILLNESS, EMOTIONAL DISTRESS, OR DEATH CAUSED IN WHOLE OR IN PART BY THE ALLEGED OR ACTUAL NEGLIGENCE OF THE RELEASEES. I further agree that if, despite this Agreement, I or anyone acting on my behalf makes a claim against any of the Releasees, I will DEFEND, INDEMNIFY, AND HOLD HARMLESS each of the Releasees from any attorneys’ fees, losses, liability, damage, or expenses which Releasees may incur as the result of such claim.
  6. I understand that this Agreement will apply every time I am on the premises or participate in the Activities. I agree that this Agreement is a contract which will be enforced to the fullest extent allowed by law and will be binding on me, my assignees, subrogors, heirs, assigns, executors, and personal representatives. If any part of this Agreement is deemed to be unenforceable, the remaining terms shall be enforceable.

WAIVER AND RELEASE
Please read this form carefully and be aware that in signing up for and participating in programs/activities, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with said programs/activities (including transportation services/vehicle operation, when provided). I recognize and acknowledge that there are certain risks of physical injury to participants in these programs/activities, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims against the Roseland Youth Center, including its officials, agents, volunteers and employees (hereinafter collectively referred as “Center”), which I or my minor child/ward may have (or that accrue to me or my child/ward) as a result of participating in these programs/activities. I do hereby fully release and forever discharge the Center from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward arising out of, connected with, or in any way associated with these programs/activities. I have read and fully understand the above important information, warning of risk, and waiver and release of all claims. If registering via fax or online, your facsimile signature shall substitute for and have the same legal effect as an original form signature. Additional field trip waiver/release will also need to be signed.

PHOTO RELEASE
Roseland Youth Center takes photographs or video of participants for promoting our programs, services, events, activities, and facilities in our brochures, website or agency social media, etc. By participating in or attending any Roseland Youth Center activities the participant (or parent/guardian of a minor participant) agrees to the use and distribution of his or her image (or images of a minor child/ward) in photographs, video recordings, and any other electronic reproductions of such activities for any purpose without inspection, compensation, or any other consideration now and in the future.

REFUND POLICY
A NON-REFUNDABLE 30% DEPOSIT IS DUE AT TIME OF BOOKING.

THE 30% DEPOSIT CAN BE TRANSFERRED ONCE, ONLY IF CLIENT CANCELS 48 HOURS PRIOR TO THE EVENT DATE. 

THE NEW BOOKING MUST BE USED WITHIN 30 DAYS OF THE ORIGINAL BOOKING. 

YOU WILL NOT BE ALLOWED TO BEGIN YOUR EVENT PRIOR TO THE TIME BOOKED.

YOU ARE RESPONSIBLE FOR THE BEHAVIOR OF ALL OF YOUR GUESTS AND SHOULD ANYONE'S BEHAVIOR IN YOUR PARTY BE DEEMED INAPPROPRIATE, VIOLENT, CRIMINAL, OR INFRINGE ON OTHERS, HE OR SHE WILL BE ESCORTED OUT AND YOUR EVENT WILL END IMMEDIATELY. 

Date: December 2, 2020

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Zip Code

Team Name

Sport/Activity
First Participant's Signature*
Second Participant's Name

First Name*

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

Zip Code

Team Name

Sport/Activity
Third Participant's Name

First Name*

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

Zip Code

Team Name

Sport/Activity
Fourth Participant's Name

First Name*

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

Zip Code

Team Name

Sport/Activity
Fifth Participant's Name

First Name*

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

Zip Code

Team Name

Sport/Activity
Sixth Participant's Name

First Name*

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

Zip Code

Team Name

Sport/Activity
Seventh Participant's Name

First Name*

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

Zip Code

Team Name

Sport/Activity
Eighth Participant's Name

First Name*

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

Zip Code

Team Name

Sport/Activity
Ninth Participant's Name

First Name*

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

Zip Code

Team Name

Sport/Activity
Tenth Participant's Name

First Name*

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

Zip Code

Team Name

Sport/Activity
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Zip Code

Team Name

Sport/Activity
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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