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CITY OF LA PORTE PARK AND RECREATION – LIABILITY WAIVER

In order to participate in the activities with the City of La Porte Park and Recreation Department, I agree to indemnify and hold harmless the La Porte Park and Recreation Department, City of La Porte, Indiana, and any elected officials, affiliates, property owners, employees, other participants, advertisers and promoters from any and all loss, claim, injury, damage, negligence, or liability sustained or incurred by me resulting therefrom. I specifically agree to indemnify and hold harmless the above-identified parties as to any loss, cost, claim, injury, damage, liability, sustained or incurred by using the City of La Porte Park and Recreation Department facilities or equipment, which is caused by an act or omission, whether negligent, intentional or otherwise of the above-identified parties. I understand that I am responsible for all medical expenses. I waive any right to make claims or lawsuits against them. I acknowledge that the activities in which I am, or my child is about to participate are not essential services provided by the City of La Porte.

I understand and acknowledge that there are certain risks involved with the activities in which I or my child are about to voluntarily participate. I understand that these risks, known or unknown, anticipated, or unanticipated, may result in injury, death, illness, disease, or damage to myself, my child, others, or property. I voluntarily agree and promise to accept and assume all responsibility for injuries, death, illness, disease or damage to myself, my child, other persons, or property that arise from participation in these activities.

My or my child’s participation in these activities is voluntary and no one is forcing us to participate, despite the risks. I understand the effect of the waiver and acceptance of risk on my legal rights.

I hereby grant to the City of La Porte Park and Recreation its agents and their respective licensees, successors, and assigns (herein collectively called “the licensed parties”) the right to use, publish and copyright my name, picture, portrait or likeness, testimonial, voice, video, photographic images, artwork in advertising, promoting, and publicizing. I agree that no advertisement or other material need be submitted to me for any further approval and the licensed parties shall be without liability to me for any distortion or illusionary effect resulting from the publication of my picture, portrait, likeness, photographic images, or artwork.

By signing this page, I agree to the above terms and conditions for myself, my immediate family, and any other guests that are a part of my group (including all minors) and my property. My signature indicates that I have read the above rules and this entire document, understand it completely, acknowledge that it cannot be modified or changed in any way by oral representations, and agree to be bound by its terms. This agreement shall be binding on behalf of my heirs, my assigns, my personal representatives, my estate, or myself.

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.


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*
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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