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Liability and Media Release Waiver Form

Insights Science Center, Inc
4120 Rio Bravo St Ste 117
El Paso, TX 79902
(915) 534-000

 

 

 

 

I Agree
I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participating in activities inside the Insights El Paso Science Center, Inc., New Mexico Property (Insights). 

I Agree
I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE (Insights), their officers, volunteers, and employees (hereinafter referred to as RELEASES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that ;/may be sustained by me or to any property belonging to me, while on or upon the premises where the event or activity is being conducted.

I Agree
I hereby grant permission to (Insights) to use (Group Involved, including minors) likeness for the purpose of promotion for all forms of media, but not limited to: photographs, video, website, news releases, promotion, and advertising for an indefinite period of time.

I Agree
I give unrestricted permission for images, videos and recordings of the (Group Involved, including minors) to be used digitally and internet media. I further acknowledge that I will not be compensated for these uses and (Insights) owns all rights to all images, videos, and recordings.

It is my expressed intent that this release and hold harmless agreement shall bind all members of my party for the proposed activity, if I am deceased, and shall be deemed as a RELEASE, WAIVE, DISCHARGE, AND CONVENTION TO SUE the above named RELEASES. I hereby further agree that this Waiver of Liability on Premises and Hold Harmless Agreement shall be constructed in accordance with the laws of the State of Texas. 

In signing this release, I acknowledge and represent that I have READ THE FOREGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed, no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BOUND BY SAME. 

First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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


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*

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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