POLE VAULT ELITE WAIVER

Transcription

1 In consideration of the services of POLE VAULT ELITE, I hereby agree to release, indemnify, and discharge POLE VAULT ELITE, on behalf of myself, the minor(s) for whom I sign (hereinafter referred to as Minor ), my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows: I acknowledge that my (or the Minor s) participation in pole vaulting activities, including pole vaulting training activities (e.g., bending poles, rope swinging, pulley drills, trampoline, and ground drills, including, but not limited to falling, coming in contact with trees, steps, rocks, ground, standards, limbs, branches, bricks, debris, other structures and devices, or other equipment or persons) entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself (or the Minor), to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: Pole vaulting activities entail certain risks that simply cannot be eliminated without jeopardizing the essential qualities of the activity. Risks include the negligence of other participants or myself (or the Minor), injuries including sprains, fractures, scrapes, bruises and cuts, dislocations, concussions, and serious injuries to the head, back, or neck which can cause paralysis, or even death. In any event, I acknowledge that if I am (or the Minor is) injured, I (or the Minor) may require medical assistance, at my own expense. I expressly agree and promise to accept and assume all of the risks existing in this activity. My (or the Minor s) participation in this activity is purely voluntary, and I (or the Minor) elect to participate in spite of the risks. When participating in this activity, I expressly agree and promise to abide by the following Rules and Regulations, including, but not limited to, the following: 1. Persons may not participate in activities unless they have a signed liability waiver on file with POLE VAULT ELITE. If a participant is under age 18, their parent or legal guardian must sign this document in the presence of a POLE VAULT ELITE representative or a notary public (there are no exceptions to this rule). 2. Participants will not be allowed to enter or remain on the POLE VAULT ELITE premises unless they are wearing full appropriate protective and safety gear for the Participation Activities in which they are participating. 3. Participants must engage in Participation Activities in a safe manner at all times and avoid collisions with other persons. 4. Participants may engage in Participation Activities in designated areas only. 5. Participants must obey the safety instructions of POLE VAULT ELITE staff at all times. Page 1 of 6

2 6. Fighting or other aggressive or disruptive behavior will result in ejection from the POLE VAULT ELITE premises. 7. Smoking is only allowed in designated areas. 8. Equipment or gear not required for participation in Participation Activities and any other items must be stored in locations outside the Participation Activities locations. 9. No illegal drugs are allowed on the POLE VAULT ELITE premises. 10. No profanity or vulgar language is permitted on the POLE VAULT ELITE premises. 11. No weapons are allowed on the POLE VAULT ELITE premises. 12. No pets other than Seeing Eye animals are allowed on the POLE VAULT ELITE premises without permission. 13. No contests of any sort are allowed on the POLE VAULT ELITE premises unless organized and run by POLE VAULT ELITE staff or other authorized persons. 14. POLE VAULT ELITE reserves the right to terminate any membership or pass at any time and to eject anyone at anytime for any reason. 15. Safeguard your valuables and possessions at all times. POLE VAULT ELITE is not responsible for lost and/or stolen items. 16. Alcohol may not be consumed prior to or during participation in any Participation Activities. 17. Participants must obey all posted rules. 18. Violations of rules may result in ejection from the POLE VAULT ELITE premises and cancellation of all memberships without refund. I UNDERSTAND AND ACKNOWLEDGE that the above list is not complete or exhaustive and that other rules may apply, including but not limited to the rules of NFHS, US Track and Field, AAU, IHSAA, or other entities. I (or the Minor) want to use the POLE VAULT ELITE s poles, pits, board runway and other training equipment and am doing so entirely upon my (or the Minor's) own initiative, risk and responsibility. Furthermore, I (or the Minor) am is aware of the risks and hazards inherent upon the use of the facilities. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless POLE VAULT ELITE from any and all claims, demands, or causes of action, which I (or the Minor) may sustain while using the pole(s) rented hereunder or in any way connected with my participation pole vaulting activities or my (or the Minor s). Should POLE VAULT ELITE or anyone acting on behalf of POLE VAULT ELITE, be required to incur attorney's fees and costs to enforce any portion this agreement, including to defend or respond to any claim which I have waived or from which I have released POLE VAULT ELITE hereunder. I agree to indemnify and hold POLE VAULT ELITE harmless for all such fees and costs. Page 2 of 6

3 I certify that I have adequate insurance to cover any injury or damage I (or the Minor) may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I (or the Minor) may have. I give my consent and permission to POLE VAULT ELITE and medical personnel to obtain or administer on my behalf or on behalf of Minor, first aid and emergency medical treatment in case of sickness, accident, injury and to secure medical care at my expense and to make decisions concerning medical care if I am unable to do so or if in the case of Minor, I am unable to be reached. I give consent for drug testing to be performed in the event of any accident or during the course of any medical care or treatment for my minor child or myself. In the event that I file a lawsuit against POLE VAULT ELITE, I agree to do so solely in Hamilton County in the state of Indiana, and I further agree that the substantive law of Indiana shall apply that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my (or the Minor s) use of the pole(s) rented hereunder, I may be found by a court of law to have waived my right to maintain a lawsuit against POLE VAULT ELITE on the basis of any claim from which I have released POLE VAULT ELITE herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. PHOTO AND VIDEO RELEASE: I, for just and sufficient consideration, receipt of which is hereby acknowledged, hereby irrevocably grant POLE VAULT ELITE, it s successors and partners the right to record my likeness and/or voice on tape, film or digital media, to edit such tape, film or digital media at our discretion; to incorporate the same into video, TV, radio, web or print advertisement or video for POLE VAULT ELITE; and to use or authorize the use of such tape, film, and videotape or any portion thereof in any manner or media at any time through the world in perpetuity and to use my likeness, voice and biographical and other information concerning me in connection there with including promotion in all media. I hereby release you and anyone using said film, digital image, or other material from any and all claims, damages, liabilities costs and expenses which I now have or may hereafter have by reason of any use thereof. Page 3 of 6

4 I understand that this is the entire agreement between POLE VAULT ELITE and myself, that it is for the benefit of all Released Parties, and that it cannot be modified or changed in any way by the representations or statements of POLE VAULT ELITE or any employee or agent of POLE VAULT ELITE or any of the Released Parties or by myself. I am at least 18 years of age, of sound mind, and not under the influence of any drugs or alcohol at this time. My signature below indicates that I have read this entire document, understand it completely, and agree to be bound by its terms. If I am the parent or guardian of the participant, I agree to be bound by the terms and conditions of this agreement and shall be responsible for the actions of the participant. THE REMAINDER OF THIS PAGE IS LEFT BLANK INTENTIONALLY Page 4 of 6

5 MINOR ACKNOWLEDGMENT AND RELEASE CERTIFICATE I know of the risks involved in athletic participation, understand that serious injury, and even death, is possible in such participation, and choose to accept such risks. I voluntarily accept any and all responsibility for my own safety and welfare while participating in athletics, with full understanding of the risks involved, and agree to release and hold harmless POLE VAULT ELITE of and from any and all responsibility and liability, including any from their own negligence, for any injury or claim resulting from such athletic participation and agree to take no legal action against POLE VAULT ELITE because of any accident or mishap involving my athletic participation. I consent to the exclusive jurisdiction and venue of courts in Hamilton County, Indiana for all claims and disputes between and among POLE VAULT ELITE and me, including but not limited to any claims or disputes involving injury. I HAVE READ THIS CAREFULLY AND KNOW IT CONTAINS A RELEASE PROVISION. (to be signed by Minor) Date: Minor Signature: Printed: Date: Witness Signature: Witness Printed Name: Page 5 of 6

6 PARENT/GUARDIAN/EMANCIPATED MINOR CONSENT, ACKNOWLEDGMENT AND RELEASE CERTIFICATE Undersigned knows of and acknowledges that the Minor knows of the risks involved in athletic participation, understands that serious injury, and even death, is possible in such participation and chooses to accept any and all responsibility for the Minor s safety and welfare while participating in athletics. With full understanding of the risks involved, undersigned releases and holds harmless POLE VAULT ELITE of and from any and all responsibility and liability, including any from their own negligence, for any injury or claim resulting from such athletic participation and agrees to take no legal action against POLE VAULT ELITE because of any accident or mishap involving the Minor s athletic participation. Undersigned consents to the exclusive jurisdiction and venue of courts in Hamilton County, Indiana for all claims and disputes between and among POLE VAULT ELITE and me or the student, including but not limited to any claims or disputes involving injury, eligibility, or rule violation. Undersigned further certifies that he/she is the parent or legal guardian of Minor or an Emancipated Minor and has the power and authority to sign this agreement on behalf of and to bind Minor to the terms hereof. I HAVE READ THIS CAREFULLY AND KNOW IT CONTAINS A RELEASE PROVISION. (to be completed and signed by all parents/guardians, emancipated minors; where divorce or separation, parent with legal custody must sign) Date: Parent/Guardian/Emancipated Minor Signature: Printed: Date: Parent/Guardian/Emancipated Minor Signature: Printed: Date: Witness Signature: Witness Printed Name: Page 6 of 6