Waiver of Damage Liability Form Free by zkw14506

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									                       Accident Waiver and Release of Liability Form
                                   Name of Activity: Summer Dance Camp

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATION IN THIS ACTIVITY, including by way of
example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or
entities being released, or because of their possible liability without fault.

I certify that I am physically fit and I certify that there are no health-related reasons or problems which preclude my
participation in this activity or event. I am fully aware of the risks and hazards connected with the participation in
this activity or event, including physical injury or even death, and hereby elect to voluntarily participate in said
activity or event, knowing that the associated physical activity may be hazardous to me and my property.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the persons or entities being
released, sponsors, and organizers of any activity or event in which I may participate in the activity listed above,
and that it will govern my actions and responsibilities of said activity or event.

I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising
from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property
damage, or actions of any kind which may hereafter occur to me including my traveling to and from this activity or
event, THE FOLLOWING ENTITIES OR PERSONS: Summer Dance Camp and/or their directors, volunteers,
representatives, the activity or event holders, activity or event sponsors, and owners of properties where
event/activity takes place.

I INDEMNIFY, HOLD HARMLESS, AND AGREE NOT TO SUE the entities or persons mentioned in the above
paragraph from any and all liabilities or claims made as a result or participation in this activity or event, whether
caused by the negligence of release or otherwise.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident,
and/or illness during this activity or event.

I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film
likeness to be used for any legitimate purpose by Summer Dance Camp event holders, sponsors, organizers and
assignees.

Severability: The undersigned further expressly agrees that the foregoing waiver is intended to be as broad and
inclusive as is permitted by the law of the State of Nebraska and that if any portion thereof is held invalid, it is
agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I signing this release, I acknowledge and represent that I HAVE READ THE FORGOING Accident Waiver and
Release of Liability Form, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no
oral representations, statements or inducements, apart from the forgoing written agreements have been made; and I
EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY
INTENDING TO BE BOUND BY SAME.

Print Participant’s Name:__________________________________________Age:_________

Signature of Participant:__________________________________________Date:__________

Print Parent/Guardian Name:____________________________________________________

Signature of Parent/Guardian:____________________________________Date:___________

								
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