Liability Release printable pdf download

Liability Release

I recognize the inherent risk of injury, disability or death from my participation or attendance at

Aegis Health Partners, PC activities at 241 Russell Street, Hadley MA. I understand that each

participant or bystander must assume the risk of injury, disability or death that could result from

these activities.

In consideration of being allowed to participate in any way in AEGIS HEALTH PARTNERS, PC related

events and activities, I, the Undersigned, acknowledge, appreciate, and agree that:

Parent/Legal Guardian or Adult Must Initial

______ 1. The risk of injury from the activities involved in this program is significant, including the potential for

permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk,

the risk of serious injury does exist; and,

_______ 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF

ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my

participation; and,

_______ 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If

however I observe any unusual significant hazard during my presence or participation, I will remove myself from

participation and,

_______ 4. I, for myself and on the behalf of my heirs, assigns, personal representatives and the next of kin,

HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS AEGIS HEALTH PARTNERS, PC, their officers,

officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable,

owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL

INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE

NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY

UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY

SIGNING IT, AND SIGN IT FREELY AND VOLUUNTARILY WITHOUT ANY INDUCEMENT.

Print Name:__________________________________________________

Participant Signature:_______________________________________________ Date:___________

Parent/Guardian Signature: ________________________________________

Date: __________

(if participant is under the age of 18)

Liability Release