WAIVER/RELEASE FORM (PRINT THIS PAGE)
MINOR WAIVER/RELEASE FORM
RELEASE OF LIABILITY FOR MINOR PARTICIPANTS
READ BEFORE SIGNING
IN CONSIDERATION OF _________________________________________, my child/ward, being allowed to participate in any way in the ninety5plus or Balbuena Consulting LLC related events and activities, and agrees that:
The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability/death, and while particular rules, equipment and personal discipline may reduce the risk, the risk of serious injury does exist; and,
1)FOR MYSELF, SPOUSE, AND CHILD, 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 child’s participation and,
2)I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately, and,
3)I myself, my spouse, my child and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS ninety5plus or Balbuena Consulting LLC or Caleb Balbuena or its directors, officers, agents, employees, volunteers, 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 incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
4)I, for myself, my spouse, my child and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, 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 VOLUNTARILY WITHOUT ANY INDUCEMENT.
PARENT/GUARDIAN SIGNATURE___________________________ PRINT NAME _______________________
DATE SIGNED _____________________
UNDERSTANDING OR RISK: I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant.
Contact information: Address: ____________________
BALBUENA CONSULTING LLC
El Dorado Hills, CA
*waiver/release to be kept on file for up to 7 years