Please read carefully
WAIVER - RELEASE OF ALL CLAIMS AND HOLD HARMLESS AGREEMENT
FOR THE CITY OF COUNTRY CLUB HILLS ACTIVITY PROGRAM Please read this form carefully and be aware that by participating in this program, you will be waiving your rights to all claims for injuries, damage or loss which may occur as a result to your participation in this event.
RISK OF INJURY: “As a participant in this program, I recognize and acknowledge that there are certain risks of physical injury. I agree to assume the full risk of injuries, including death, damages, or loss which may be sustained as a result of participating in any and all activities associated with this program.” WAIVER OF INJURY CLAIMS: “I agree to waive and relinquish any and all claims I may have arising out of, connected
with, or in any way associated with the activities of the program.”
RELEASE FROM LIABILITY: “I do hereby fully release and discharge the City of Country Club Hills and its officers, agents and employees from any and all claims from injuries, including death, damage or loss which may occur as a result
of my participation in this program.” INDEMNITY AND DEFENSE: “I further agree to indemnify, hold harmless and defend the City of Country Club Hills, and its officers, agents, and employees from any and all claims from injuries, including death, damages and losses sustained by me arising out of, connected with, or in any way associated with the activities of this program.” In the event of any emergency, I authorize the City of Country Club Hills to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed reasonable and necessary for my immediate care and agree that I will be responsible for payment of any and all medical services rendered. I have read and fully understand and agree to the above stated conditions of participating in City of Country Club Hills Activity Program(s).
Release:
I understand there are risks of physical injury in participating in sports and recreational activities or programs.
I hereby release the City of Country Club Hills, IL, its employees, officials and agents from any and all liability or loss or damage to personal property that, my child or I may experience in connection with activities sponsored by Country Club Hills Parks and Recreation.
I hereby consent to emergency medical procedures deemed advisable for my child in the event I cannot be reached and my child has sustained an injury. The Dept. does not provide accident or hospitalization insurance for participants of its programs. All participants are advised to have adequate personal coverage. Please consider participant's own health, experience, and tolerance for risk before participating in any program.I also consent to the use of my or my child’s photo, video, artwork etc. by the dept for flyers, presentations etc.
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