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FULCRUM FIVES

ASSUMPTION OF RISK, WAIVER, AND RELEASE FROM LIABILITY AGREEMENT

In consideration of the use of the property, facilities, services, and/or programs of MAZ, LLC or FULCRUM FIVES LLC (hereinafter, “Fulcrum Fives”), the undersigned agrees as follows:

RISK FACTORS. The undersigned understands and acknowledges that the use of equipment and facilities provided by Fulcrum Fives and participation in youth and adult soccer activity (including, but not limited to, field rental, league play, pick up games, individual and/or group practice, and soccer-themed parties and events) involves risk including, but not limited to, the following: risk of property damage, bodily injury, including but not limited to sprains, abrasions, bone fractures, concussions, permanent disability, paralysis, and possibly death. These risks may result from the use of the fields, equipment, facilities, from the activity itself, from the acts of others, or from the unavailability of emergency medical care.

ASSUMPTION OF THE RISK. The undersigned voluntarily assumes, today and on all future dates, all the risks that may arise out of or result from the use of the equipment or facilities, from the activity itself, from the acts of others, or from the unavailability of emergency medical care.

PREREQUISITE SKILLS. The undersigned acknowledges that he or she has the requisite skills, qualifications, physical and mental ability, necessary to properly and safely use the equipment, facilities, and to participate in the activity. The undersigned affirms that he or she will cease activity and inform Fulcrum Fives of any health problem that arises during participation.

WAIVER. The undersigned waives the protection afforded by any statute or law in any jurisdiction whose purpose, substance and/or effect is to provide that a general release shall not extend to claims, material or otherwise which the person giving the release does not know or suspect to exist at the time of executing the release. This means, in part, that the undersigned is releasing unknown future claims.

REPRESENTATIVES. The undersigned enters into this Assumption of Risk, Waiver, and Release from Liability Agreement for him/herself, his/her heirs, assigns, and legal representatives.

INDEMNIFY AND DEFEND. The undersigned hereby releases, waives, indemnifies and holds Fulcrum Fives and all of its officers, managers, trustees, directors, employees, and agents (hereinafter jointly referred to as “indemnitee”) harmless from any and all claims, causes of action, suits, liability, losses, or damages for any property damage, property loss or theft, personal injury, death or other loss arising from or relating to the undersigned’s use of the property, facilities, services, and/or programs of Fulcrum Fives. The undersigned hereby further release waives, indemnifies and holds CUC Properties IV, LLC and all of its officers, trustees, directors, employees, and agents (hereinafter jointly referred to as “Premises Owner”) harmless from any and all claims, causes of action, suits, liability, losses, or damages for any property damage, property loss or theft, personal injury, death or other loss arising from or relating to the undersigned’s use of the property, facilities, services, and/or programs of Fulcrum Fives.

INFECTIOUS DISEASES. By the signing of this waiver and release from liability, the undersigned acknowledges the contagious nature of COVID-19 and other infectious diseases, and voluntarily assumes the risk that they may be exposed to or infected by COVID-19 or other infectious diseases by use of the property, facilities, services, and/or programs of Fulcrum Fives and that such exposure or infection may result in personal injury, illness, permanent disability, and death. The undersigned understands that the risk of becoming exposed to or infected by COVID-19 or other infectious diseases at, or on the premises of, Fulcrum Fives may result from the actions, omissions, or negligence of themselves and others, including, but not limited to, Fulcrum Fives and its officers, directors, employees, agents, representatives, volunteers, and program participants and their families.

The undersigned voluntarily agrees to assume all of the foregoing risks and accepts sole responsibility for any injury to themselves (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that they may experience or incur in connection with their attendance at, or on the premises of, Fulcrum Fives or participation in Fulcrum Fives’ programs (“Claims”). The undersigned hereby releases, covenants not to sue, discharges, and holds harmless Fulcrum Fives, its officers, directors, employees, agents and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. The undersigned agree that this release includes any Claims based on the actions, omissions, or negligence of Fulcrum Fives, its officers, directors, employees, agents and representatives, whether an infection due to COVID-19 or other infectious disease occurs before, during, or after participation in or use of the property, facilities, services, and/or programs of Fulcrum Fives.

CONSENT FOR EMERGENCY TREATMENT. The undersigned, as a participant in the subject activity, hereby consent to medical treatment in a medical emergency where the undersigned is unable to consent to such treatment.

INSURANCE. The undersigned understands that Fulcrum Fives does not carry participant insurance and that the undersigned will be solely responsible for any medical, health or personal injury costs relating to undersigned’s use of the property, facilities, services, and/or programs of Fulcrum Fives. The undersigned is encouraged to have a medical physical examination and purchase health insurance prior to any and all participation.

FILM AND PHOTOGRAPHY. By entering the premises, the undersigned consents to: photography, audio recording, video recording, and its/their release, publication, exhibition, or production to be used for promotional purposes, advertising, inclusion on websites, social media, or any other purpose by Fulcrum Fives and its affiliates and representatives or other authorized persons or assigns. The undersigned releases Fulcrum Fives and its indemnitee from any liability connected with the taking, recording, publication, or use of photographs, video, and sound recordings. By entering the premises, the undersigned waives all rights he or she may have to any claims for payment or royalties in connection with any use of these materials, irrespective of whether a fee for admission or sponsorship is charged.

JURISDICTION. This Assumption of Risk, Waiver, and Release from Liability Agreement shall be governed in all respects by the laws of the State of Ohio. The parties agree to venue in the Hamilton County Courthouse in Ohio.

PAY. The undersigned agrees to pay for any and all damages, including attorney fees and collection costs, to any property or indemnitee caused by the undersigned negligently, willfully or otherwise.

SEVERABILITY. If any term, clause, or provision of this Assumption of Risk, Waiver, and Release from Liability Agreement is held to be illegal, invalid or unenforceable, or the application thereof to any person or circumstance shall to any extent be illegal, invalid or unenforceable under present or future laws effective during the term hereof or of any provisions hereof which survive termination, then and in any such event, it is the express intention of the parties that the remainder of this Agreement, or the application of such term, clause or provision other than to those as to which it is held illegal, invalid or unenforceable, shall not be affected thereby, and each term, clause or provision of this Assumption of Risk, Waiver, and Release from Liability Agreement and the application thereof shall be legal, valid and enforceable to the fullest extent permitted by law.

CUSTOMER CODE OF CONDUCT. To ensure the safety and comfort of all customers and employees at Fulcrum Fives, the following conduct is required for all Fulcrum Fives customers and other visitors while on the Fulcrum Fives premises: treat all Fulcrum Fives employees and fellow customers with courtesy and respect; avoid the use of profane, sexist, racist, or other offensive or inappropriate language while on the premises; and refrain from any physical contact with Fulcrum Fives employees beyond a simple handshake. Fulcrum Fives reserves the right to remove and/or ban from its premises any individual or customer that violates this Code of Conduct or engages in any behavior that is deemed to be threatening or unwelcome.

ACKNOWLEDGMENT. The undersigned enters into this Assumption of Risk, Waiver, and Release from Liability Agreement and realizes it relates to surrendering and releasing valuable legal rights and does so freely and voluntarily.

Consent and Release on Behalf of Minor (If Player is a minor)

I am the parent or legal guardian of the below named minor. I have read and understand this Assumption of Risk, Waiver, and Release from Liability Agreement and realize it relates to surrendering valuable legal rights of the minor and myself. I agree to be bound by all the terms of the agreement. I also give my consent to the participation in the activity of the minor.

 

Date signed: September 19, 2021

First Player's Name

First Name*

Last Name*
First Player's Date of Birth*
First Player's Information

Phone Number (in case of emergency): *
First Player's Signature*
Second Player's Name

First Name*

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

Phone Number (in case of emergency): *
Third Player's Name

First Name*

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

Phone Number (in case of emergency): *
Fourth Player's Name

First Name*

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

Phone Number (in case of emergency): *
Fifth Player's Name

First Name*

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

Phone Number (in case of emergency): *
Sixth Player's Name

First Name*

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

Phone Number (in case of emergency): *
Seventh Player's Name

First Name*

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

Phone Number (in case of emergency): *
Eighth Player's Name

First Name*

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

Phone Number (in case of emergency): *
Ninth Player's Name

First Name*

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

Phone Number (in case of emergency): *
Tenth Player's Name

First Name*

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

Phone Number (in case of emergency): *
Parent or Guardian's Email Address

Email*

Confirm Email*
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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*
Parent or Guardian's Information

Phone Number (in case of emergency): *
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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