Loading...

SRG Waiver & Release Form

PARTICIPANT WAIVER OF LIABILITY
In consideration of myself being admitted, voluntarily, to participate in today’s event being hosted and run by the Schuylkill River Greenway Association (“Association”), I release and hold the Association, its officers, directors, employees, sub-contractors, sponsors, agents and affiliates harmless from all present and future claims that may be made by me, my family, estate, heirs, executors, administrators, or assigns for property damage, personal injury, or wrongful death arising as a result of my participation in today's event wherever, whenever, or however the same may occur, including all claims arising out of the actions of third parties.

I understand that participation may involve certain risks, including, but not limited to, serious injury and death, and I am voluntarily participating with knowledge of the danger involved and I agree to accept all risks of said participation. I also agree to indemnify and hold harmless the Association for any and all claims arising out of my participation, including claims made by third parties.

I acknowledge that novel coronavirus (“Covid-19”) infections have been confirmed throughout the United States as well as within the county and region in which the activities listed above will occur.  I further acknowledge that participating in such activities comes with the inherent risk of contracting Covid-19 from SRGA staff, other participants or the general public.  I agree to adhere to all Covid-19 related protocol and restrictions in place as promulgated by the Commonwealth of Pennsylvania and required by SRGA.  


PARTICIPANT RELEASE OF IMAGE
I give permission for my photograph to be taken during this event and activity and for the organizers of this activity to use my photographic image for any advertising or publicity for this and other Schuylkill River Greenway Association events.
I have read and understand the release and agree to it voluntarily.

December 21, 2024

First Participant's Name

First Name*

Middle Name

Last Name*
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*
Parent or Guardian's Email Address

Email*

Confirm Email*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!