
Download a Copy by clicking the link - communical disease release form.pdf
RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
COMMUNICABLE DISEASE
7/28/2020
Participant’s Name___________________________________________Birthdate___________________
Street Address___________________________________________City___________Zip_____________
Parent/Guardian’s Name_________________________________Emergency Phone_________________
Parent/Guardian’s Name_________________________________Emergency Phone_________________
In consideration of being allowed to participate in any way in any CEGCYRA programs, related events, and/or activities, I the undersigned, acknowledge, appreciate, and agree that:
I am aware that there are risks to me of exposure, whether directly or indirectly, arising out of, contributed to/by, or resulting from an outbreak of any and all communicable diseases, including but not limited to, the virus “severe acute respiratory syndrome coronavirus (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19) and/or any mutation or variation thereof.
I, on behalf of myself, and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE CONGERVILLE, EUREKA, GOODFIELD COMMUNITY YOUTH RECREATION ASSOCIATION, its MEMBER LEAGUES AND CLUB, its directors, officers, officials, agents and/or employees, associated personnel, other participants, sponsors, advertisers, and if applicable owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, 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 VOLUNTARILY WITHOUT ANY INDUCEMENT.
X_________________________________________________________ ____________ ______________
Signature of Participant aged 18 or older Age Date
FOR PARENTS/GUARDIANS OF PARTICIPANT UNDER AGE 18 (MINOR) AT TIME OF REGISTRATION
This is to verify that I, as parent/guardian of __________________________ with legal responsibility for this Participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENE OF THE RELEASEES, to the fullest extent permitted by law.
X___________________________________________________________________ ________________________ Signature of Parent/Guardian for Participant under age 18 Date
X__________________________________________________ __________________
Signature of Parent/Guardian for Participant under age 18 Date