Required fields are marked with asterisks (*)

Release and Indemnification Form for Recreation Activities

Please have a parent or guardian complete the form below in order to participate in recreation activities with the Town of Prescott.

Date:

Event/Program Title

First Name

Last Name

Name(s) of child(ren)/the "Participant(s)"

Phone Number

Emergency Contact Name and Phone Number

Medical Information (Allergies, Epi-pen Required, Other Medical Conditions)

Permission to Email - Stay up to date! We would like to provide you with email communication regarding recreation and community services within the Town of Prescott.

Yes

BY SIGNING THIS RELEASE AGREEMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT. PLEASE READ CAREFULLY!

Town of Prescott holds the safety of participants in a high regard. Participants and parents/guardians of minors taking part must recognize the inherent risk of injury when choosing to participate in recreational activities.

I am the participant or the parent/legal guardian of (list names):

I certify that I am over the age of 18. Enter age below:

(the “Participant”), who desires to attend at and participate recreation activities offered by the Town of Prescott. On behalf of the Participant, myself, the Participant’s parent(s) or guardian(s), heir(s), estate, insurers, assigns and anyone else who may make any claim for or on behalf of the Participant, I hereby irrevocably and unconditionally accept and fully assume all risks, dangers and hazards and the possibility of personal injury, death, property damage or loss, resulting from the participants participation in this recreational activity

I am aware that the physical exertion required to participate in recreational activities can activate or aggravate pre-existing injuries and conditions. I am responsible for consulting with my physician prior to engaging in physical recreational activity.

Clear

I acknowledge that I have been advised to wear appropriate safety and protection gear while using any of the sport rentals equipment. I am responsible for obtaining additional equipment for the safe and proper use for all recreation, sports & equipment.

Clear

I assume legal liability and waive all claims of injuries, damages or loss I may sustain while participating in any recreational activities associated with this registration.

Clear

I will not hold the Town of Prescott responsible for any loss, damages or injuries resulting from the use or misuse of the equipment.

Clear

The participant shall, indemnify and save harmless the Corporation of the Town of Prescott, their elected officials, officers, employees and others who the Town is responsible from and against any and all claims, actions, losses, expenses, fines, costs (including legal costs), interest or damages of every nature and kind whatsoever, including but not limited to bodily injury or to damage to or destruction of tangible property including loss of revenue arising out of or allegedly attributable to the negligence acts, errors, omissions, whether willful or otherwise by the participant, their officers, employees, agents, or others who the participant is legally responsible.

I acknowledge the above statement.

Clear

I declare that I have read and understood the above Release and Indemnification Form for Recreation Activities in its entirety and I hereby agree to be bound by the terms and conditions. I am aware that by signing this agreement, I am waiving certain legal rights which I, my heirs, next of kin, executors, administrators and assigns may have against the Town of Prescott, its officers, directors, servants, employees and agents.

I HAVE READ AND UNDERSTOOD AND INTEND TO BE BOUND BY THIS AGREEMENT IN ITS ENTIRETY. I EXECUTE THIS AGREEMENT VOLUNTARILY.

Clear

NAME OF PARTICIPANT/GUARDIAN:

This form may contain personal information or information that is otherwise confidential and is intended for the exclusive use of the intended recipient. The contents hereof are protected under the rights and privileges of the Municipal Freedom of Information and Protection of Privacy legislation.