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Berkley Pub Crawl Waiver August 25, 2016
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
NAME OF PARTICIPANT
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ADDRESS OF PARTICIPANT
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PHONE NUMBER
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BIRTH DATE
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EMERGENCY CONTACT
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RELATIONSHIP
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TELEPHONE
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DISCLAIMER CLAUSE The organizers of the Berkley Pub Crawl, the Berkely Area Chamber of Commerce and any of their employees, volunteers, members and representatives are not responsible for any injury, loss or damage of any kind sustained by any person while participating in the Berkley Pub Crawl including injury or loss or damage.
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ASSUMPTION OF RISKS: In consideration of my participation in the Berkley Pub Crawl, I acknowledge that I am aware of the possible risks, dangers and hazards associated with my participation in the Berkley Pub Crawl Crawl, (including the possible risk of severe or fatal injury to myself or others). These risks include but are not limited to the following: a) the risks associated with travel to and from location(s) to be visited during the Berkley Pub Crawl, including transportation provided by commercial, private and/or public motor vehicles; b) intoxication and/or alcohol poisoning from the alcohol I consume whether voluntarily or through coercion; c) the possibility of bodily injury (broken bones and soft tissue damage) including dental damages from falling down, injuries incurred while getting on or off (in or out of) the mode of transportation being used for the event, being knocked down or being involved in a physical confrontation whether caused by myself or someone else; d) the risks associated with returning to my residence.
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INDEMNIFICATION AND RELEASE OF LIABILITY: In return for the Chamber allowing me to voluntarily participate in the Berkley Pub Crawl and related activities, I agree: 1. TO ASSUME AND ACCEPT ALL RISKS arising out of, associated with or related to my participating in the Berkley Pub Crawl; 2. TO BE SOLELY RESPONSIBLE FOR ANY INJURY, LOSS OR DAMAGE which I might sustain while participating in the Berkley Pub Crawl; 3. TO HOLD HARMLESS AND INDEMNIFY THE ORGANIZERS OF THE Berkley Pub CRAWL: a) from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my participation in the Berkley Pub Crawl and all related activities; and b) from any and all claims, demands, actions and costs which might arise out of my participating in the Berkley Pub Crawl;
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Protection of Privacy - The personal information requested on this form will ONLY be used for the purpose of implementing this waiver. But if you would like to be put on our email list to receive updates on upcoming community events please ADD EMAIL
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ACKNOWLEDGEMENT I acknowledge that I have read this agreement, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, executors, administrators and representatives, in the event of my death or incapacity.
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I understand that my photo may be taken and used by the Chamber for promotional purposes.
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By typing my name below I am signing this waiver and verifying that I am 21 or older.
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