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Power Haus Sports- Birthday Party Participant Waiver
Please take a moment to fill out the information below - THIS FORM IS REQURED BEFORE ENTERING THE PARTY VENUE
Email address *
Name of person attending the party *
Your answer
Parents name if under the age of 18 *
Your answer
Who's Birthday Party are you attending? *
Your answer
Date of the event *
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WAIVER AND RELEASE OF LIABILITY In consideration of being allowed to participate in any way in any of the Metro East Power Haus athletic/sports programs and related activities, and birthday parties, the undersigned: A. Agrees that prior to participating, he/she will inspect the facilities and equipment to be used and if he/she believes anything is unsafe, he/she will immediately advise their coach or supervisor of such condition(s) and refuse to participate. B. Acknowledges and fully understands that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death and severe social and economic losses which might result from their own actions, inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to Metro East Power Haus Inc. or reasonably foreseeable at this time. C. Assumes all the foregoing risks and accepts personal responsibility for damages which may hereinafter occur following such injury, permanent disability or death. D. Releases, waives, discharges and covenants not to sue Metro East Power Haus Inc, Ziklag LLC, their respective administrators, directors, agents, coaches and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leaser of the premises used to conduct an event, all of which are hereafter referred to as “RELEASEES” from demands, losses or damages on account of injury from future participation, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the “RELEASEES” or otherwise. Metro East Power Haus Inc, Ziklag LLC, which ares individual Illinois Corporations. E. Agrees to carry personal health insurance in case of a sports injury. F. RELEASES THE "RELEASEES" AND EXPRESSLY ASSUMES THE RISK OF INJURY AND DAMAGES; and will indemnify and hold harmless the “RELEASEES” as to any claims for injury and damage. You grant Metro East Power Haus Inc, Ziklag LLC,the right to utilize your image (or your child's image) on any reproduction for marketing purposes, including but not limited to brochures, banners, website, social media, print, video, and billboards. MINOR RELEASE AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF ATHLETIC/SPORTS PROGRAMS AND RELATED ACTIVITIES, AND THE MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE’S FROM ALL LIABILITY CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATION AND FURTHER AGREE THAT IF, DESPITE THIS *
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