City of Hawaiian Gardens
Activity Registration Form
Adult First Name
Adult Last Name
Address Line 2
Emergency Phone Number
Your Text Here
Name of Participant
Name of School
PLEASE READ AND SIGN THE WAIVER AND INDEMNITY AGREEMENT BELOW
PLEASE READ AND SIGN THE WAIVER AND INDEMNITY AGREEMENT BELOW In consideration of being permitted to participate in the City of Hawaiian Gardens recreational program and to use City facilities and/or those facilities not owned by but made available through the City in conjunction with the program (collectively referred to herein as “City Facilities”), the undersigned, on behalf of himself or herself, and on behalf on any minors in the legal custody of the undersigned, and on behalf of the undersigned’s personal representatives, heirs, assigns and next of kin, agrees to the following:
1. The undersigned herby releases , waives, discharges, covenants not to sue, agrees to indemnity and save harmless the City of Hawaiian Gardens, its officers, agents, employees, volunteers and representatives (collectively “City”), for and against any loss, damage, or cost, including, without limitation, any claims or demands on account of personal injury, property damage or death, including attorney’s fees, which may occur as a result of the named participant(s)’ (“Participant”) presence during or participating in the program and/or use of any City Facilities and/or City equipment while participating in the program, even though that injury or damage may arise out of negligence of the City or out of a dangerous or defective condition of property or equipment of the City or City Facilities. This release and indemnity shall further extend to owner of any facility on which Program activities occur.
2. The undersigned hereby assumes full responsibility for and risk of bodily injury, death or property damage while the participating is present /during or participating in the program. The undersigned expressly acknowledge and understands that accidents and injuries can occur while present during or participating in the Program, including serious and permanent personal injuries or death, and that the undersigned hereby expressly assumes all of the risks due the negligence of the City or due to a dangerous or defective condition of public property, otherwise , whether or not particular risk is known or unknown.
3. The undersigned expressly agrees and hereby given permission for, and expressly assumes the risk of, any emergency medical treatment that may be rendered , at the sole discretion of the City, to the Participant if the Participant is injured while present at or participating in the program. The undersigned hereby agree to expressly release and indemnify the City against any liability for providing, or failing to provide, any emergency medical treatment as asset forth herein. The undersigned further agrees to pay all costs incurred because of said treatment.
4. The undersigned expressly agrees that foregoing Release and Waiver of Liability and Indemnity Agreement is intended to be as broad and inclusive as permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect 5. This covenant is intended by the parties to be a waiver of California Civil Code Section 1542 which reads as followed: “A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release which if known by him must materially affected his settlement with the debtor.” 6. I further consent to the use of activity/event photography and/or video taping of my child or myself and the display of those pictures for promotional use, including on the City’s Internet site.
The undersigned has read and voluntarily signs this Release and Indemnity Agreement, and further agrees that no representations, statement, or inducements of any kind, apart from the foregoing written Agreement, have been made.