Loading...

Liability and Injury Waiver


Acknowledgment of Risks:

I, the undersigned, acknowledge that participation in activities at Purcellville Sportsplex LLC involves inherent risks, including but not limited to physical injury, property damage, or death. I understand that these risks may arise from my own actions, the actions of others, and the conditions of the facilities.

Release of Liability:

In consideration of being allowed to participate in activities at Purcellville Sportsplex LLC, I hereby release, waive, and discharge Purcellville Sportsplex LLC, its owners, employees, agents, and affiliates from any and all claims, demands, actions, or causes of action arising out of or related to any loss, injury, or damage that may be sustained while participating in activities or while on the premises.

Indemnification:

I agree to indemnify and hold harmless Purcellville Sportsplex LLC, its owners, employees, agents, and affiliates from any and all claims, damages, losses, or expenses, including attorney’s fees, arising out of my participation in activities or use of the facilities, whether caused by my negligence or otherwise.

Medical Treatment:

In the event of an injury or medical emergency, I authorize Purcellville Sportsplex LLC to provide or seek medical treatment on my behalf. I understand that I am responsible for all costs associated with such treatment.

Acknowledgment of Understanding:

I have read this waiver and fully understand its terms. I am signing this waiver voluntarily and intend for it to be a complete and unconditional release of all liability to the greatest extent allowed by law.

July 14, 2025

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
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*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
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!