Liability Waiver Form
Shelter Ministries, Inc. | 16825 Goshawk Road West | Black Forest, CO 80908
I am fully aware of the risks and hazards connected with the participation in recreational and/or work activities at Shelter Pines, including physical injury or even death, and hereby elect to voluntarily participate in said event, knowing that the associated physical activity may be hazardous to me, my family, and to my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, my family, my group, or loss or damage to property owned by me/my family/my group, as a result in participation in this activity.
I hereby RELEASE, WAIVE, DISCHARGE, and COVENANT NOT TO SUE Shelter Ministries, its Board of Directors, or any employees of Shelter Ministries, from any and all liability, claims, demands, action and causes of actions whatsoever arising of or related to any loss, damage or injury, including death, that may be sustained by me, my family, my group, or to any property belonging to me/family/group, while participating in physical activity, or while on or upon the premises where the event is being conducted.
It is my expressed intent that this release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns, and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVE, DISCHARGE, and CONVENTION TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of Colorado.
In signing this release, I acknowledge and represent that I HAVE READ THE FORGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENTING TO BE BOUND BY SAME.
By checking the box, I acknowledge that this serves as my Electronic Signature.
Please Print FULL NAME on the line below.
Guardian/Parent Name if participant(s) is under 18
If part of a group (organization/agency/church), please provide the name of the group:
Send me a copy of my responses.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service