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Release, Waiver of Liability, and Assumption of Risk
Centerville City (Adult Form)
I understand that participation in any Centerville City programs, training, classes, camps, and sporting activities (“program activities”) carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks may include: (1) minor injuries such as sunburn, windburn, scratches, bruises, blisters, and sprains; (2) major injuries, such as eye injury or loss of sight, joint or back injuries, concussions, and broken bones; (3) catastrophic injuries as well as paralysis and death; and (4) possible exposure to and illness from infectious diseases, including, but not limited to COVID-19. I acknowledge the inherent risks involved in my participation in Centerville City program activities and accept and fully assume all risk of participation.
I recognize that Centerville City program activities may cause me to experience some degree of physical and/or mental stress. I state that to the best of my knowledge I am free from any known heart, lung, or other serious health problems that could prevent me from safely participating in program activities. I understand that City staff and/or volunteers are not medical professionals and are not trained to diagnose, monitor, or treat chronic or acute medical conditions, whether pre-existing or caused by participation in Centerville City program activities. In the event I am injured or become ill while participating in Centerville City program activities, I hereby give Centerville City staff and/or volunteers permission to administer first aid and/or to secure emergency medical care for me. I acknowledge and represent I have adequate health insurance or resources to cover the costs of medical care for myself if necessary.
In consideration of my participation in Centerville City program activities, I, for myself and my successors, representatives, heirs, executors, and assigns, hereby voluntarily and knowingly indemnify and hold harmless, defend, release, waive, and discharge Centerville City, and its officers, employees, and volunteers from any and all suits, claims, or liability, including negligence, based on any injury or damage as a result of my participation in the Centerville City program activities. This waiver and release is expressly intended to discharge Centerville City, its officers, employees, and volunteers from and against any and all liability arising out of or in connection with my participation in the Centerville City program activities, except for liability, injury, or damages caused solely by the willful misconduct of Centerville City, its officers, employees, and volunteers. In addition, I understand that no insurance is provided by Centerville City, including, but not limited to, property, medical, health and/or accident insurance. I agree that my insurance company or I will pay for medical, hospitalization, or any other expenses resulting from my participation in Centerville City program activities.
This waiver and release is intended to be as broad and inclusive as is permitted by the laws of the State of Utah. If any portion is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and legal effect. I understand and acknowledge that Centerville City does not waive or intend to waive any provisions, rights, immunities, and protections provided by Utah Governmental Immunity Act, as set forth in Utah Code §§ 63G-7-101, et seq. I further agree and understand that the laws of the State of Utah shall govern this waiver and release and that jurisdiction and venue for any suit or cause of action under this waiver and release shall lie in the courts of Davis County, Utah.
I agree to all of the terms and conditions of participation and hereby waive and release any prospective claims against Centerville City as provided herein. This waiver and release shall apply to me as well as my successors, representatives, heirs, executors, and assigns. I further acknowledge that I have read this waiver and release and understand its contents.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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