|
CITYOFSANTAANAr
<br />RISK MANAGEMENT a d i v i s i on of HUMAN RESOURCES +�
<br />Managing Risk Positive Change
<br />CITY OF SANTA ANA
<br />Waiver and Liability Release Form 2023
<br />Title of EventlActivity:
<br />Event Date:
<br />Description of Event/Activity:
<br />NO EXCEPTIONS: Each participant must submit/bring a signed original document, or sign in person.
<br />THIS IS A WAIVER OF YOUR LEGAL RIGHTS AND AN AGREEMENT NOT TO SUE.
<br />In consideration for the City of Santa Ana allowing me or, if applicable, my minor child to voluntarily participate in the above -
<br />named activity/event, I agree for myself and, if applicable, for my minor child as follows (initial each section):
<br />_DC_ I am aware that participation in the above -named activity may result in injury to myself or others, including but not limited to,
<br />bodily injury, personal injury, death, disability, illness, property damage, or loss (collectively, referred to as "Risk of Injury"),
<br />and that I am voluntarily participating in this activity with the full knowledge of the Risk of Injury.
<br />12C I hereby accept responsibility for any and all Risk of Injury on behalf of myself, my minor child (if applicable), my spouse, my
<br />heirs, executors, administrators, representatives and assigns, or, if applicable, the heirs, executors, administrators,
<br />representatives and assigns of my minor child, and anyone who might claim on my behalf, and, if applicable, on behalf of
<br />my minor child, and on all such behalves.
<br />_DPI do hereby release and forever discharge, defend, indemnify and hold harmless City of Santa Ana, and their respective
<br />officials, officers, agents, volunteers, contractors, or employees (collectively, the "Released Parties") from any liability for
<br />any and all claims, demands, causes of action, damages, judgments, costs or expenses, including attorneys' fees and other
<br />litigation costs, which may in any way result from, or in any way arise out of, participation in the above named activity.
<br />n I understand that this release and waiver extends to all claims of every kind or nature whatsoever, either in law or in equity,
<br />foreseen or unforeseen, known or unknown, which arise or may hereafter arise from my or, if applicable, my minor child's
<br />participation in the above named activity and that this release and waiver discharges the Released Parties from any liability
<br />or claim that I or, if applicable, my minor child may have against the Released Parties, or any of them, with respect to any
<br />Risk of Injury that may result from my, or, if applicable, my minor child's participation in the above -named activity, whether
<br />caused by the negligence of the Released Parties, or their respective officials, officers, agents, volunteers, contractors, or
<br />employees.
<br />_MI agree to observe and obey all rules and warnings, and further agree to follow instructions or directions given by the
<br />employees, representatives, or agents of the City of Santa Ana.
<br />DC I do hereby release and forever discharge the Released Parties from any claim whatsoever which arises or may hereafter
<br />arise on account of any first aid, treatment, or service rendered in connection with my or, if applicable, my minor child's
<br />participation in the above named activity or with the decision by any representative or agent of the Released Parties, or any
<br />of them, to exercise the power to consent to medical or dental treatment as such power may be granted by me for my minor
<br />child.
<br />Waiver and Liability Release Form 2023 Revised 912212023
<br />
|