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Islamorada, Village of Islands

Parks and Recreation Department

Release, Waiver and Indemnification Agreement

 Activity: All Adult Sports, Programs and Activities at facilities owned by Islamorada, Village of Islands.


I, the undersigned, agree that Islamorada, Village of Islands (the “Village”) and its officers, agents and employees shall not be held liable for injuries, death or other loss which may occur as a result of my participation in the above described activity, and that the undersigned voluntarily assumes the risk of any loss, injury or death to person or loss or damage to property, which in any way arises out of participation in said activity. Further, the undersigned WAIVES ANY CLAIM against the Village and its officers, agents and employees arising from loss, injury, death or damage and does COVENANT NOT TO SUE the Village and its officers, agents and employees. Further, the undersigned agrees to RELEASE, INDEMNIFY, DEFEND AND HOLD HARMLESS the Village and its officers, agents and employees from any and all claims, actions, demands, rights, judgments liability or expenses arising from or by reason of any and all know or unknown damages, claims or actions arising from participation in the above-described activity. This indemnification and hold harmless shall continue notwithstanding any negligence or comparative negligence on the part of the Village relating to such loss, injury, or damage. I hereby give permission for the Village and its officers, agents and employees to call my physician and or to arrange for transportation to a hospital in the event of any injury, although I understand that the Village and its officers, agents and employees assume no responsibility to do so. Participant also acknowledges and understands that the Village and its contractors, partners and/or sponsors may use photographs, video or film for educational, informational or promotional purposes, and Participant hereby grants the Village and its contractors, partners and sponsors permission to use images of Participant or Participant’s likeness for any purpose with no compensation or liability. I hereby agree that this Release form shall be binding on my heirs, successors and assigns. The undersigned has fully read, understood and agrees to each term contained in this Release, Waiver and Indemnification Agreement.


Today's Date: April 23, 2024

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*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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(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*

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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