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Liability Waiver
Program Participant/Park User Liability Waiver
Consent and Release
(Required)
The undersigned hereby acknowledges that:
I recognize and acknowledge that there are risks associated with the aforementioned activity/program/event/general use of the Park and Park Lands (collectively the “Use of the Park”) and that I or my child/ward should not engage in the Use of the Park unless medically able to do so. I further acknowledge that there are risks associated with outdoor activities I or my child/ward are choosing to engage in on land owned and/or operated by the Preservations Parks of Delaware County. On behalf of myself and my child/ward, I assume all risks associated with the Use of the Park including but not limited to: falls; trips; contact with equipment or materials; effects of weather; contact with other participants or park users, the natural environment, hazardous materials, and animals, which may act in unpredictable ways. I understand that neither the Preservation Parks of Delaware County, nor any of its commissioners, officers, employees, agents, volunteers or sponsors assume any responsibility or liability with respect to my or my child/ward’s Use of the Park.
As part of the consideration tendered for me or my child’s/ward’s Use of the Park, or Program Participation, I hereby agree that neither my child nor myself, nor our respective heirs, assigns, guardians and legal representatives will make a claim against the Preservation Parks, or any of its affiliated organizations, officers or directors, board, board members, agents, employees and/or volunteer workers for injury or death to me or my child/ward or damage to mine or my child’s/ward’s property, however caused, arising from my, or my child’s/ward’s Use of the Park. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions, or causes of action resulting in personal
injury or death to me or my child/ward, or damage to my or my child’s/ward’s property, sustained in connection with my/ their/our Use of the Park.
I further hereby agree to indemnify and save harmless the Preservation Parks, its affiliated organizations, officers or directors, board, board members, agents, employees and/or volunteer workers against any claim for damages,
compensation, or otherwise, on behalf of myself, or my child/ward, our assignees, heirs, guardians, executors, administrators, or personal representatives, and agree to reimburse or make good any loss or damages, or costs, including attorney’s fees, that the Preservation Parks may have to pay if any litigation arises on account of any claims to the Preservation Parks.
I authorize the Preservation Parks to use my and/or my child’s/ward’s name, statements and likeness, without charge, for promotional purposes in park publications, advertising, video, web, news media, or other format.
Participant's/Park User's Name
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Participant's/Park User's Signature
(Required)
I have read and voluntarily signed this form.
Date
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Emergency Contact Name
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Emergency Contact Relationship
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Emergency Contact Phone Number
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Age of Participant/Park User
(Required)
18 or Above
Under 18
Name of Parent/Legal Guardian
Parent/Legal Guardian Phone
Signature of Parent/Legal Guardian
Date
MM slash DD slash YYYY
Participant/Park User Responses
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