2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
13. WAIVER AND RELEASE FROM LIABILITY FOR OWNER OF LAND USED BY PARTICIPANT
    WAIVER AND RELEASE FROM LIABILITY FOR OWNER OF LAND USED BY PARTICIPANT I, (hereinafter referred to as “PARTICIPANT/PARENT/GUARDIAN”) HEREBY WAIVE AND RELEASE FROM LIABILITY, indemnify, hold harmless and forever discharge TOWN OF SPRINGDALE (hereinafter referred to as “OWNER”) and its agents, staff, employees, affiliates, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, including any claims of owner or employee negligence, whether known or unknown, in law or equity, that I ever had or may have, arising from or in any way related to my participation in any of the events or activities, and for the duration or my stay, conducted by, on the premises of, or for the benefit of the Canyon Community Center Fitness Classes, provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct. PARTICIPANT/PARENT/GUARDIAN acknowledges that PARTICIPANT/PARENT/GUARDIAN’S presence on the abovementioned property is voluntary and primarily for PARTICIPANT/PARENT/GUARDIAN’S own benefit. PARTICIPANT/PARENT/GUARDIAN understands that PARTICIPANT/PARENT/GUARDIAN’S presence on this property may expose PARTICIPANT/PARENT/GUARDIAN to dangerous conditions including but not limited to snakes, insects and spiders, ditches, erosions of the land whether man-made or natural, sharp rocks, etc. PARTICIPANT/PARENT/GUARDIAN hereby waives all claims for damages, injuries and death sustained to PARTICIPANT/PARENT/GUARDIAN or PARTICIPANT/PARENT/GUARDIAN’S property, that PARTICIPANT/PARENT/GUARDIAN may have against the aforementioned released party to such activity or conditions. PARTICIPANT/PARENT/GUARDIAN assumes any risk, and takes full responsibility and waives any claims of personal injury, death or damage to personal property associated with OWNER including but not limited to man-made hazards associated with the property and natural hazards such as holes, ditches, culverts, fallen trees, branches, fence posts, ice, snow, mud or other irregularities and using the terrain or surrounding land for any use including related activities on and off the premises, whether or NOT attributable to PARTICIPANT/PARENT/GUARDIAN’S own neglect or fault, including use of all motorized vehicles, whether deemed safe or otherwise. PARTICIPANT/PARENT/GUARDIAN further understands that OWNER makes no claims or representations about fitness for use of the property and the surrounding land for any particular purpose, other than that stated, and makes no warranties, either expressed or implied, as to the safety of the premises, and that PARTICIPANT/PARENT/GUARDIAN is using said property at PARTICIPANT/PARENT/GUARDIAN’S own risk. This WAIVER AND RELEASE FROM LIABILITY contains the entire agreement between the parties, and supersedes any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE FROM LIABILITY. The provisions of this WAIVER AND RELEASE FROM LIABILITY may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties. The provisions of this WAIVER AND RELEASE FROM LIABILITY will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of OWNER, whether by agreement, by operation of law, or otherwise. PARTICIPANT/PARENT/GUARDIAN acknowledges having read, understanding and fully agreeing to the terms of this WAIVER AND RELEASE FROM LIABILITY. PARTICIPANT/PARENT/GUARDIAN understands and confirms that by signing this WAIVER AND RELEASE FROM LIABILITY that PARTICIPANT/PARENT/GUARDIAN has given up considerable future legal rights. PARTICIPANT/PARENT/GUARDIAN (or Agent) has signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. PARTICIPANT/PARENT/GUARDIAN (or Agent’s) signature is proof of PARTICIPANT/PARENT/GUARDIAN’S intention to execute a complete and unconditional WAIVER AND RELEASE FROM LIABILITY to the full extent of the law. PARTICIPANT/PARENT/GUARDIAN is 18 years of age or older and mentally competent to enter into this waiver. This Agreement and its terms and provisions will include any minors who accompany PARTICIPANT/PARENT/GUARDIAN and any other person or property arising from PARTICIPANT/PARENT/GUARDIAN’S presence or activities on said property. PARTICIPANT/PARENT/GUARDIAN agrees to assume responsibility for watching and caring for the safety of any person accompanying PARTICIPANT/PARENT/GUARDIAN and guarding against all hazards, whether explicitly mentioned in this WAIVER AND RELEASE FROM LIABILITY or otherwise.
15. PLEASE CHECK BOX BELOW TO AGREE TO TERMS OUTLINE ABOVE

    1. I agree
17. By typing your full name in the field below you affirm that the information provided is true and accurate:
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field