Adult Waiver/Release
AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY
READ BEFORE SIGNING
In consideration of being allowed to participate in any way in
(Name of Organization)
athletic sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees
that:
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 RELEASEES 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 bring such to the attention of the nearest official immediately; and,
4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE AND HOLD HARMLESS ____________________________________(Name of
Organization) their directors, officers, officials, agents, volunteers 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 VOLUNTARILY WITHOUT ANY
INDUCEMENT.
________________________________________________________ DATE SIGNED:______________________
(Participant’s Signature)
FOR PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT THE TIME OF REGISTRATION)
This is to certify that I, as parent/guardian 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 liabilities incident to my minor
child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR
NEGLIGENCE, to the fullest extent permitted by law.
_________________________________________________ DATE SIGNED:_____________________
(Parent/Guardian Signature)
Emergency Phone Number:_(________)_________________
This is a SAMPLE WAIVER FORM only. Final wording should be directed by the insured’s counsel, but must observe
the principles represented within the above. This form provided courtesy of K&K Insurance Group.
This signed waiver/release should be kept on file by the sports organization for at least 7 years or possibly longer if the
player has been involved in a serious injury.
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Burlington CC
MLCC
Swift Strikers
Swift Strikers
