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SPECIAL OLYMPICS
RELEASE AND WAIVER
OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY, AND
PARENTAL CONSENT AGREEMENT ("AGREEMENT")
In consideration of participating in the Polar Plunge XV, I represent that I understand the nature of the Polar Plunge event and that I and/or my minor child am qualified, in good health, and in proper physical condition to participate in such an Activity. I acknowledge that if I and/or my minor child believe event conditions are unsafe, I and/or my minor child will immediately discontinue participation in the Activity.
I fully understand that the Polar Plunge XV event involve risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my own actions or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the "releases" named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I and /or my minor child incur as a result of my and/or my minor child's participation in the Activity.
I hereby release, discharge, and covenant
not to sue Special Olympics Virginia, event sponsors,
its respective administrations, directors, agents, officers,
volunteers, employees, other participants, any sponsors,
advertisers, and if applicable, owners and lessons of
premises on which the Activity takes place (each considered
one of the "RELEASES" herein), from all liability,
claims, demands, losses, or damages on my account and/or
that of my minor child caused or alleged to be caused
in whole or in part by the negligence of the "releases"
or otherwise, including negligent rescue operations;
and I further agree that if, despite this release, waiver
of liability, and assumption of risk, I, or anyone on
my/and or my minor child’s behalf, makes a claim against
any of the "Releases," I will indemnify, save,
and hold harmless each of the releases from any loss,
liability, damage, or cost which any may incur as the
result of such claim.
I have read this RELEASE AND WAIVER
OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT,
AND PARENTAL CONSENT AGREEMENT, understand that I have
given up substantial rights by signing it and have signed
it freely and without any inducement or assurance of
any nature and intend it be a complete and unconditional
release of all liability to the greatest extend allowed
by law and agree that if any portion of this agreement
is held to be invalid the balance, notwithstanding,
shall continue in full force and effect.
__________________________
Date
___________________________________________
Printed name of participant
___________________________________________
Signature of Participant (only if age 18 or over)
___________________________________________
Signature of Parent/Legal Guardian
(if participant under age 18)
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