The School District Of Palm Beach County - Release/waiver Of Liability And Hold Harmless Agreement For An Adult

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THE SCHOOL DISTRICT OF PALM BEACH COUNTY
Release/Waiver of Liability and Hold Harmless
Agreement for an Adult
(Participant 18 Years of Age or Older)
Directions: Complete this form and return it to your school.
I
, have been informed and know the risks involved in participating in this
event, and understand that serious injury, and even death, is possible in such
participation and I choose to accept such risk. I voluntarily accept any and all responsibility for my own safety and
welfare while participating in this event, with the full understanding of the risks involved. I hold harmless and release the
SCHOOL BOARD OF PALM BEACH COUNTY, FLORIDA, ITS REPRESENTATIVES, MEMBERS, OFFICERS,
EMPLOYEES, VOLUNTEERS, CONTRACTORS AND/OR AGENTS of any and all responsibility and liability for any
injury or claim resulting from my participation in this event.
In consideration for being allowed to participate in the
event,
I, for my heirs, executors and administrators, release and forever discharge the SCHOOL BOARD OF PALM
BEACH COUNTY, FLORIDA, ITS REPRESENTATIVES, MEMBERS, OFFICERS, EMPLOYEES, VOLUNTEERS,
CONTRACTORS AND/OR AGENTS of all liability, claims, actions, damages, and/or costs/expenses I may have
against them, arising out of or in any way connected with my participation in this event on (date)
.
I understand that this release/waiver of liability applies to ANY claim, even those based upon the negligence,
actions or inactions of those referenced above, including the SCHOOL BOARD OF PALM BEACH COUNTY,
FLORIDA, ITS REPRESENTATIVES, MEMBERS, OFFICERS, EMPLOYEES, VOLUNTEERS, CONTRACTORS AND/
OR AGENTS.
I HAVE READ THIS CAREFULLY, UNDERSTAND IT, AND KNOW IT CONTAINS A RELEASE/WAIVER OF
LIABILITY.
Participant Signature
Date
Participant Print Name
PBSD 2449 (New: 03/12/2012)
RECORD COPY - School

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