2020 YMCA of Boulder Valley Liability Waiver
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YMCA of Boulder Valley

Grant of Permission and Waiver of Liability

This Grant of Permission and Waiver of Liability (“Grant & Waiver”) is by and between the Parent or Legal Guardian (”Guardian”) listed below on behalf of the Student (“Student”) listed below, and the YMCA of Boulder Valley (“YMCA”), a Colorado non-profit corporation located at 2800 Dagny Way, Lafayette, Colorado, 80026, for the Centaurus Safe Night After Prom held on May 2, 2020 (“Event”).


1.Guardian grants permission for Student to attend the Event at the YMCA.

2.Guardian grants permission to the YMCA to use, without obligation, photographs, film footage or tape recordings, which may include Student’s image or voice for purposes of promoting or interpreting YMCA programs.


1.Guardian hereby releases YMCA, its employees, officers, directors, volunteers, and agents from any and all claims for injury, death, loss or damage that Guardian or Student may suffer as a result of participation during the Event.

2.Guardian gives consent to YMCA to secure emergency care as needed or prescribed for Student, at Guardian’s sole expense. This care may be given under whatever conditions are necessary to preserve life, limb or wellbeing of Student.

3.Guardian releases YMCA from any liability resulting in damaged, lost, or stolen items that Student may experience during the Event.

4.Guardian is responsible for Student’s actions and will cooperate with YMCA or Event staff if Student is unable to participate in Event due to inappropriate behavior.

By continuing with this registration, you agree, warrant and covenant as follows:

In consideration of the acceptance of my entry, I, the undersigned participant, for myself, my family members, heirs, administrators, personal representatives, successors and assigns hereby fully release, discharge and hold harmless Big Wheel Rally LTD (“Big Wheel Rally”), High Roller USA LLC (“High Roller USA”), any sponsors, owners and operators of event vehicles and officers, directors, employees, volunteers and lessors of any of the foregoing persons or entities from any and all liability, whether resulting from negligence of any aspect of the event, whether a pre-ride, post-ride activity or the ride itself. I also expressly covenant with the aforementioned persons and entities not to sue any such persons and entities for any such activity, including the negligence of any such persons or entities. I certify and represent by my application for entry that my physical condition is adequate to compete safely in the event, and I hereby acknowledge that the above persons and entities have no obligation to provide medical care and have not undertaken the responsibility to do so. In the event I receive medical care as a result of a medical emergency, I hereby consent to such care and fully release the person(s) providing such care from any and all liability, whether resulting from negligence or otherwise. I authorize and consent to the publication, whether by videotape, film, newsprint, written advertisement or otherwise, of any materials containing my name or picture, and I release any sponsors and all persons acting under authority from any claims I might have due to initial or subsequent publication of any such materials or photographs. I hereby certify that I have fully read and understand the foregoing release, waiver and covenant not to sue and sign it knowingly, willingly and voluntarily. If signing as a parent, guardian or agent on behalf of a minor participant, I certify that I have the actual authority to sign this Waiver on behalf of such minor.

Authority to Register and/or to Act as Agent. You represent and warrant to the Big Wheel Rally and High Roller USA that you have full legal authority to complete this event registration, including full authority to make use of the credit or debit card to which registration fees will be charged. In addition, if you are registering third parties, you represent and warrant that you have been duly authorized to act as agent on behalf of such parties in performing this event registration. By proceeding with this event registration, you agree that the terms of this Registration Agreement shall apply equally to you and to any third parties for whom you are acting as agent. Compliance with Children’s Online Privacy Protection Act (COPPA). You represent and warrant that, in compliance with COPPA, you are over thirteen (13) years of age, and that if you are registering a child under fourteen (14) years of age you are the parent of such child, and do hereby consent to the collection of such child’s personal information.

By indicating your acceptance of this waiver and release, you are affirming that you have read and understand this agreement and waiver and fully understand its terms. You understand that you are giving up substantial rights, including the right to sue. You acknowledge that you are signing the agreement and waiver freely and voluntarily, and intend by your acceptance to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Student First Name *
Your answer
Student Last Name *
Your answer
Student Cell Phone Number (only to be used for prize notification and will not be shared) *
Your answer
Parent/Legal Guardian Name *
Your answer
I have read and agree to all terms and conditions above. (Parent/Legal Guardian Initials for consent) *
Your answer
Relationship to Student *
Student's Grade - (After Prom is for Juniors and Seniors. Freshman and Sophomores who are NOT attending Prom should not plan on attending After Prom) *
Student's School *
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