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liability waiver and release _please print clearly_ - 16th Street Station

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liability waiver and release _please print clearly_ - 16th Street Station Powered By Docstoc
					                              LIABILITY WAIVER AND RELEASE
                                 (PLEASE PRINT CLEARLY)



_____________________________________________________________________________
First                     MI                        Last


______________________________________________________________________________
Address


______________________________________________________________________________
City                      State                     Zip


______________________________________________________________________________
Phone                     Phone (emergency)         Email address


I, _________________________, am entering the historic Train Station building, generally bounded by
16th and 18th Streets and between Wood and Frontage Roads (APN 018-0310-013-01) and the land
surrounding such building, of my own free will. I understand that the building is in a dilapidated and
dangerous state. I understand that it is my responsibility to adhere to and comply with the policies and
procedures as indicated by the person coordinating my entrance on the property. I realize precautions are
taken to reduce any injuries or hazards from this activity; however in the event of an injury or damage, I
hereby waive, release and agree to defend, indemnify and hold harmless 16th Street Station LLC and
BUILD West Oakland, LLC (“BUILD”) its directors, officers, employees and agents from any liability
for damages of personal injury including, but not limited to, accidental death, as well as from claims for
property damage which may arise in connection with the above described activity, whether such injuries
or damage are foreseen or unforeseen. 16th Street Station LLC and BUILD, and any and all otherwise
officially named sponsors shall not be responsible to compensate, indemnify or pay damages to any
person participating in the above described activity, for any reason whatsoever.

I HAVE CAREFULLY READ THIS LIABILITY WAIVER AND RELEASE, AND I
FULLY UNDERSTAND ITS CONTENT. I HOLD HARMLESS AND AGREE NOT TO
FILE A CLAIM OR TAKE OTHER LEGAL ACTION AGAINST BUILD. I AM AWARE
THAT THIS IS A FULL WAIVER AND RELEASE OF ALL LIABILITY, AND
AGREEMENT TO INDEMNIFY AND I SIGN IT OF MY OWN FREE WILL.


Signature:________________________________ Date:___________________________


Signature:________________________________ Date:___________________________
(If person engaging in activity is under 18 years of age, parent or legal guardian must sign)



                                                                                         Revised 1/25/2012

				
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