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SOUTH SOUND ROLLER DERBY

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

 

("Agreement") IN CONSIDERATION of being permitted to participate, in any way, at any time, in flat track roller derby, skating practice, public appearances, fundraising activities, team meetings, or any other sanctioned South Sound Roller Derby (“SSRD”) activity, including travel to and from the aforementioned activities (“Activity”), I, for myself, my personal representatives, assigns, heirs, and next of kin:

 

1. ACKNOWLEDGE, agree, and represent that I understand the nature of this Activity, and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if, at any time, I believe the conditions to be unsafe, I will immediately discontinue further participation in this Activity and bring such unsafe conditions to the attention of the nearest official immediately, if appropriate. I further agree I hold medical insurance to cover any expenses related to any potential injury that may arise from participation in this Activity and the "RELEASEES" named below will not be responsible for any costs – medical or personal – incurred as a result of participation in the Activity. I willingly agree to comply with the terms and conditions for participation in the Activity.

 

2. FULLY UNDERSTAND that: (a) THIS ACTIVITY INVOLVES RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("Risks"); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the conditions in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS or social and economic losses either not known to me or not readily foreseeable at this time; (d) while rules, equipment, and personal discipline may reduce these risks, the risks remains; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation, in the Activity.

 

3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE South Sound Roller Derby, their administrators, directors, agents, officers, members, volunteers, and employees, other participants, officials, sponsors, advertisers, owners and lessees of Premises on which the Activity is conducted, (each of the foregoing shall be considered one of the RELEASEES herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, I, or anyone on my behalf, make(s) a claim against any of the RELEASEES, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim.

 

4. HEREBY GRANT South Sound Roller Derby permission to use, edit, alter, copy, exhibit, publish, sell, or distribute photos and videos of my likeness for purposes of publicizing South Sound Roller Derby's programs or for any other related, lawful purpose, including fundraising endeavors. I understand and agree that any photograph using my likeness will become property of South Sound Roller Derby and will not be returned. I acknowledge that since my participation with South Sound Roller Derby is voluntary, I will receive no financial compensation.

 

I ACKNOWLEDGE THAT I AM OVER THE AGE OF 18 YEARS, HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS, I HAVE HAD THE OPPORTUNITY TO ASK ANY QUESTIONS ABOUT THIS AGREEMENT, I HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE, AND I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

PLEASE PRINT CLEARLY

 

I understand that SSRD requires all participants to provide proof of vaccination against COVID-19 or to wear a mask to all team Activities and participation in the Activity is conditional upon my proof of vaccination or masked status. I hereby agree to show proof of vaccination or wear a mask to all Activities. I agree to self-monitor for signs and symptoms of COVID-19 (including fever, cough, and shortness of breath, among others) and not participate in any SSRD Activity if I am experiencing symptoms.


Today's Date: September 18, 2024

First Participant's Name

First Name*

Last Name*

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

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Pronouns
Pronouns
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Pronouns
Pronouns
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Pronouns
Pronouns
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Pronouns
Pronouns
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Pronouns
Pronouns
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Pronouns
Pronouns
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Pronouns
Pronouns
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Pronouns
Pronouns
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Pronouns
Pronouns
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

Emergency Contact Name *

Emergency Contact Phone Number *
COVID-19 Vaccine Information
  
Upload an image providing proof of having received any COVID-19 vaccination or booster. If you prefer not to provide proof we ask that wear a mask at practices and other league events. Thank you.
Valid file types: JPG, GIF, PNG, and PDF
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 Pronouns
Pronouns
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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