This Liability Disclaimer is used by an organization that is holding an activity to shield
itself from any liability arising from individuals' participation in the activity. Liability
disclaimers are commonly used when organizations hold events or activities that may
result in damages or injuries. By requiring the participants to sign the liability disclaimer,
the organization can protect itself from claims of injury or damages that may arise from
the activity. This document is used as a safety precaution by an organization holding an
activity or event.
Liability Release for _______________ Activity
________________ (“Participant”) hereby releases ___________________________
(“Provider”) from any claims for loss, damage, or injury sustained while participating in
_________________________________________ (the “Activity”).
Provider does not maintain any liability insurance for protection of individuals, business entities,
groups, organizations, spectators, or others who may participate in the Activity.
In consideration for participation in the Activity, the undersigned individual, business entity,
group, organization, spectator, or other, does hereby release and forever discharge Provider, and
its officers, directors, agents, and employees, jointly and severally, from any and all actions,
causes of actions, claims, and demands for, upon, or by reason of any damage, loss or injury, of
any kind or nature, which may be sustained by participating in the Activity.
This Liability Release extends, applies to, covers, and includes, all unknown, unforeseen,
unanticipated, and unsuspected injuries, damages, losses, and liabilities and the consequences
thereof, as well as those now disclosed and known to exist.
Participant hereby agrees, on behalf of his or her heirs, executors, administrators, and assigns, to
indemnify Provider and its officers, directors, agents and employees, joint and severally from
any and all actions, causes of actions, claims and demands for, upon or by reason of any damage,
loss or injury, of any kind or nature which may be sustained by participating in the Activity.
It is further understood and agreed that participation in Activity is not to be construed as an
admission of liability or acceptance or assumption of responsibility by Provider, its officers,
directors, agents, and employees, jointly and severally, for any damages and/or expenses for
which Provider, its officers, directors, agents, and employees, become liable as a result of any
alleged act of the Participant.
Name of Organization Name of Individual Responsible (Print)
All Participants must complete this Liability Disclaimer to be eligible to participate in the
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Return completed form with Entry Form to:
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