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ACTIVITY: ALL YOUTH SPORTS, PROGRAMS, AND ACTIVITIES AT FACILITIES OWNED BY

ISLAMORADA, VILLAGE OF ISLANDS


PLEASE DESCRIBE ANY SPECIAL MEDICAL NEEDS/CONDITIONS ON REVERSE SIDE

INDEMNITY AND RELEASE

I, the undersigned parent or legal guardian of the minor, whose name appears above, consent and agree that the above-named minor may participate in the Village sponsored or provided activities. The undersigned further agrees that Islamorada, Village of Islands (the “Village”) and its officers, agents, representatives, volunteers and employees will not be held liable for injuries or other loss sustained by the minor which occur as a result of the above-named minor’s participation in the Village sponsored or provided activities.

The undersigned hereby authorizes the Village to call my physician and/or arrange for transportation to a hospital in the event of any injury, although I understand that the Village and its officers, agents and employees assume no responsibility to do so

The undersigned parent/guardian, specifically WAIVES ANY CLAIM against the Village and its officers, agents, representatives, volunteers and employees. The undersigned hereby RELEASES, DISCHARGES AND COVENANTS NOT TO SUE the Village any loss, injury or damage or death sustained by the above-named minor that arises out of participation in the Village sponsored or provided activities, whether caused in whole or part by the negligence of the Village or by the negligence of the officers, agents, representatives, volunteers, or employees by the village.

Further, the undersigned parent/guardian, agrees to INDEMNIFY, DEFEND AND HOLD HARMLESS the Village and its officers, agents, representatives, volunteers and employees from any and all claims, actions, demands, rights, judgments or expenses arising from or by reason of any and all known damages, claims or actions arising from the above-named minor’s participation in the Village sponsored or provided activities.

The undersigned understands that the Village is not responsible for damage to or loss of money or personal property arising during or before or after the minor child’s participation in any activity.

This WAIVER, RELEASE and INDEMNITY shall continue notwithstanding any negligence or comparative negligence on the part of the Village relating to any loss, injury or damage.

Participant also acknowledges and understands that the Village and its contractors, partners and/or sponsors may use photographs, video or film for educational, informational or promotional purposes, and Participant hereby grants the Village and its contractors, partners and sponsors permission to use images of Participant or Participant’s likeness for any purpose with no compensation or liability.

The undersigned parent/guardian, also agree that this Waiver and Release form shall be binding on my heirs, successors and assigns.

By signing below, the undersigned parent/guardian acknowledges that (he/she) has fully read, understood and agrees to each and every term contained in this Waiver and Release.


Today's Date: April 25, 2024


First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Age

Age
First Participant's Signature*
Second Participant's Name

First Name*

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

Age
Third Participant's Name

First Name*

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

Age
Fourth Participant's Name

First Name*

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

Age
Fifth Participant's Name

First Name*

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

Age
Sixth Participant's Name

First Name*

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

Age
Seventh Participant's Name

First Name*

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

Age
Eighth Participant's Name

First Name*

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

Age
Ninth Participant's Name

First Name*

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

Age
Tenth Participant's Name

First Name*

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

Age
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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 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.


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 Date of Birth*
Parent or Guardian's Age

Age
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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