FAX COVER SHEET by jennyyingdi

VIEWS: 10 PAGES: 2

									                                Athlete’s – Participant’s
                                Waiver – Release Form                                                         Initials &
                                                                                                              Signature
                                                County of San Diego                                           Required
                                    DPW / Traffic Engineering, Special Event Permits                          As Noted!
                                 5469 Kearny Villa Rd., # 201, San Diego, CA 92123-1159
                                       Phone (858) 874-4040 Fax (858) 874-4028
         This is a contract with legal consequences. I have
         been advised to read it carefully before signing.                                                                 Initials
1.       I hereby waive, release and discharge for myself,                                           my heirs, legal
representatives, executors, administrators, assignees, and successors in interest (collectively referred to as
“Successors”) any and all rights and claims for damages, injuries, expenses or costs of any kind which I have
now or may acquire in the future that are directly or indirectly related to my participation in or association with the
Event (collectively referred to as “Claims”), against the County of San Diego, law enforcement agencies, the
sponsors, organizers and any promoting organizations for this Event, and their respective agents, officials, and
employees (collectively referred to as the “Released Parties”). The waived, released and discharged Claims
include claims arising from the Released Parties’ own active or passive negligence.                                     Initials
2. I acknowledge and fully realize the dangers of participating in a
athletic event and fully assume the risks associated with participation including, by way of example and not
limitation, the following: the dangers of collision with pedestrians, vehicles, other participants, and fixed objects;
the dangers arising from surface hazards, equipment failure, inadequate safety equipment, the Released Parties’
Own Negligence, weather conditions; and the possibility of serious physical and/or mental trauma or injury
associated with athletic events.                                                                                       Initials
3.       I agree it is my sole responsibility                               to be familiar with the course and any
special regulations for the Event. I understand and agree that situations may arise during the Event that are
beyond the immediate control of Event supervisors and organizers and I must continually participate so as to
neither endanger myself or others. I accept responsibility for the condition and adequacy of my equipment. For
bicycle events I will ride wearing a helmet that satisfies requirements of the U.S. Cycling Federation’s Racing
Rules capable of protecting against serious head injury. I assume all responsibility for the selection of the helmet.
I have no physical or mental condition, which to my knowledge, would endanger others or myself if I participate in
this Event, or would interfere with my ability to participate in this Event.                                          Initials
4. I agree for myself and Successors that the above representations are
contractually binding and are not mere recitals, and that should I or my Successors assert a claim in
contravention of this agreement, the asserting party shall be liable for the expenses (including legal fees) incurred
by the other party or parties defending, unless the other party or parties are finally adjudged liable on such claim
for willful and wanton negligence. This agreement may not be modified orally. Waiver of any provision of this
agreement is intended to be severable. If one or more provision is found to be unenforceable or invalid, the
remaining terms and provisions shall remain binding and enforceable.                                                  Initials
Type of event (description):      Bicycle Ride Along County Roads
Participant’s Name (printed):                                                Club/Team Name:
Address:                                                                     City, State & Zip
Age:             Home Phone:                        Work Phone:                       Other Phone:
Who to notify in case of emergency (printed):                                               Phone:
                                                                                                                           Sign &
     X
                                                                                                                            date
Signature of Event Participant (also initial above paragraphs as noted)                                Date

           Consent and Release of Parent or Guardian
I, as the parent or guardian of the above named minor hereby give permission for my child or ward to participate
in the Event and further agree, individually and on behalf of my child or ward, to all terms stated above.
     X                                                                                                                     Sign &
                                                                                                                            date
Signature of Parent or Guardian (also initial above paragraphs as noted)                               Date

Submit form with original signature to the County                 Athlete/Participant to make duplicate original for their records.
                           RELEASE OF LIABILITY AND WAIVER OF ALL CLAIMS
Participant and/or Participant’s parent(s) or guardian(s) acknowledge that bicycling is an inherently dangerous activity that
involves risk of accident, property damage, serious bodily injury, and death. By signing this Release, Participant, and/or
Participant’s parents(s) or guardian, assume full responsibility for any risk of injury, property damage, or death arising out of
Participant’s participation in the Alpine Challenge Bike Ride and after party (the “Event”) staged, in part, at the Viejas Outlet
Center (the “VOC”). Participant agrees that Viejas Enterprises and the Viejas Band of Kumeyaay Indians, including without
limitation, all affiliates, divisions, members, officers, attorneys, employees, agents, assigns, representatives, or successors
(collectively “Viejas”), are not responsible for any injury or damages of Participant arising out of, or related to, the Event or
Participant’s use of the VOC relating to the event.
Participant and/or Participant’s parent(s) or guardian (collectively “Releasing Parties”) hereby waive, release, and forever
discharge any and all claims for damages, loss, personal injury, or death that Releasing Parties may encounter related to or
arising out of Releasing Parties’ activities at the Event or VOC. This Release is intended to fully and completely discharge
Viejas from any and all liability for any loss, damage, or expense that Releasing Parties or Releasing Parties’ respective heirs,
assigns and legal representatives may suffer as a result of Releasing Parties’ activities at the Event or VOC, from any cause
whatsoever, including without limitation, negligence or breach of contract on the part of Viejas in the operation, supervision,
design, maintenance, or condition of the VOC and all surrounding areas. This release is intended to be as broad and inclusive
as permitted by law, and is intended to be effective and binding upon Releasing Parties’ heirs, next of kin, families, relatives,
guardians, conservators, executors, administrators, trustees and assigns.
Participant certifies that: (a) Participant has been advised to consult a physician before participating in the Event; (b) Participant
is in good physical health sufficient to participate in the Event; (c) Participant has been advised to wear a bicycle safety helmet
during the Event and (d) Participant is not taking any medication that would prevent Participant from safely participating in the
Event. Participant and/or Participant’s parent(s) or guardian agree to follow all rules posted at the VOC and instructions from the
operating staff of the Event and VOC. Failure to follow rules posted at the VOC, or instructions from the operating staff of the
Event and VOC may result in the termination of Participant's use of the VOC.
Releasing Parties agree to, at Releasing Parties’ sole expense, and with legal counsel reasonably acceptable to Viejas, defend,
indemnify and hold harmless Viejas from and against any and all accidents, injuries, liability, claims, costs or expenses related
to any act, error, omission, or negligence of Releasing Parities, arising out of, or related to, Releasing Parties’ participating in
the Event or use of the VOC. Releasing Parties hereby authorize Viejas to use any photographs, videotapes, recordings or any
other records taken of Releasing Parties while at the Event or VOC for publicity, advertising, or any other legitimate purpose.
Viejas retains and does not waive its sovereign immunity from unconsented suit or legal process.
BY SIGNING THIS RELEASE, I UNDERSTAND THAT I AM RELEASING VIEJAS FROM ANY POTENTIAL CLAIMS FOR
DAMAGES CAUSED BY THE NEGLIGENCE OF VIEJAS.
Name of Participant:                                                                                    Age:
Address:
City:                                          State:                       Zip:               Phone:
Participant’s Signature:                                                                                Date:

This is to certify that I, as parent or guardian with legal responsibility for the Participant, do consent and agree to his/her release
as provided above. To the fullest extent permitted by law, I hereby release and agree to indemnify Viejas from any and all
liabilities incident to the Participant’s involvement or participation in the Event or use of the VOC, even if arising from the
negligence of Viejas.
Parent/Guardian Signature:
Emergency Phone No:                                                                                     Date

								
To top