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Athletic Waiver


This form must be completed in order to participate in Summer at Siena.
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT ("AGREEMENT")
 
Summer, 2017
 
PLEASE READ AND SIGN BELOW  
 
I request that my child be permitted to participate in the above-referenced Activity. By signing this agreement, I allow my child to participate in the Activity despite any known or unknown risks associated with the Activity which could result in physical or emotional injury or loss to my child. 
I understand the nature of the Activity and my child’s experience and capabilities and I believe my child to be qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue my child’s further participation in the Activity.
I understand that the Activity involves risks and dangers of serious bodily injury, including permanent disability, paralysis, and death; (b) these risks and dangers may be caused by my child’s actions or inaction’s, the actions or inaction’s of others participating in the Activity, the condition in which the Activity takes place, activities which are preliminary and/or subsequent thereto, or the negligence of the “Releasees” named below; and (c) there may be other risk and social economic losses either not known to me or not readily foreseeable at this time.
In consideration of Summer at Siena furnishing services to my child enabling him/her to participate in the Activity, I hereby assume all risk of injury or loss that may occur to my child and any loss of or damage to property that may arise out of my child’s participation in the Activity including those activities which are preliminary and/or subsequent thereto. I specifically release, forever discharge and hold harmless Summer at Siena, its officers, agents, employees, insurers, volunteers, successors, and assigns, known or unknown, (each considered one of the "Releasees" herein) from any and all liabilities, actions, causes of action, damages, claims, or demands which I, my heirs, executors, administrators, or assigns may have against the Releasees for all injuries, losses, damages to persons or property, and acts of active or passive negligence on the part of the Releasees, which my child may incur by participating in the Activity including those activities which are preliminary and/or subsequent thereto.
I further understand that Summer at Siena does not carry medical insurance covering my child, and that any insurance coverage existing with respect to Summer at Siena shall not alter the terms of this release nor impose any liability on Summer at Siena, its officers, agents, employees, volunteers, insurers, successors or assigns.
I have read the above Agreement and understand all of the terms contained therein. I execute this Agreement voluntarily and with full knowledge of its significance.
Name of Participating Child
Date
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Name of Parent/Guardian
Parent Email Address
Electronic Signature of Parent/Guardian
Yes
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