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Player Registration Form

PLAYER INFORMATION

MEDICAL/EMERGENCY CONTACT INFORMATION
Town of Kensington Waiver (Required):
TOWN OF KENSINGTON PARKS AND RECREATION
ACKNOWLEDGMENT OF RISKS, GENERAL RELEASE, AND INDEMNITY AGREEMENT
THIS IS A LEGAL DOCUMENT. PLEASE READ CAREFULLY BEFORE SIGNING.

In consideration of being permitted to sign up and participate in and/or visit and observe recreational activities,
programs, and/or facilities of the Town of Kensington, and in consideration of being permitted in any way to access
the property, equipment and/or facilities of the Town of Kensington, I agree as follows:
I. ACKNOWLEDGEMENT OF RISKS. Recreational activities, programs, equipment, and facilities have inherent
risks even in a controlled environment. It is impossible to enumerate all of the possible ways in which injuries may
occur. Some examples include but are not limited to: (1) misuse of equipment or facilities; (2) physical contact with
equipment; (3) failure of the facilities or equipment; (4) mental or physical health problems of myself or others; and
(5) negligence of myself or others. I agree and acknowledge that:
A. The above list is not complete and that other unknown or unanticipated risks may result in bodily injury, property
damage, permanent disability, paralysis, death, or other loss for me or for others.
B. I am, and all other individuals are, responsible for our own safety.
C. I have responsibilities to discontinue my participation if I believe the conditions are unsafe.
D. I have no mental or physical problems or limitations that might compromise or affect my ability to participate in
recreational activities and recreational programs and use of the equipment, facilities, and property.
E. I am fully capable of participating in these activities without causing harm to me or others.
F. I will follow any and all policies, rules, and regulations as the same may be amended from time to time.
G. Individuals are available to answer any questions about the nature and physical demands of these activities and
the risks associated with these activities.
H. There are no assurances of my own safety and I assume all risks involved in my participation.
I. My participation or attendance is purely voluntary, and I choose to participate in or attend such activities in spite
of, and with complete knowledge of, the risks of injury to me or others.
I ASSUME AND ACCEPT FULL RESPONSIBILITY FOR ALL RISKS IDENTIFIED HERE AND FOR THOSE RISKS NOT
IDENTIFIED, AND FOR BODILY INJURY, PROPERTY DAMAGE, PERMANENT DISABILITY, DEATH, PARALYSIS, OR
OTHER LOSS SUFFERED BY ME AS A RESULT OF THOSE RISKS, MY OWN NEGLIGENCE OR OTHER CONDUCT, OR THE
NEGLIGENCE OF THE RELEASEES.
II. RELEASE. I HEREBY WAIVE, RELEASE, AND DISCHARGE (AND COVENANT NOT TO SUE) THE
TOWN OF KENSINGTON, ITS OFFICIALS, OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES,
AFFILIATES, VOLUNTEERS, AND ALL OTHER PERSONS OR ENTITIES ASSOCIATED WITH THE
TOWN OF KENSINGTON (COLLECTIVELY, THE ?RELEASEES?) FROM ALL LIABILITIES, CLAIMS,
DEMANDS, LOSSES, DAMAGES, OR CAUSES OF ACTION RELATED TO ANY INJURY TO, OR ILLNESS,
DEATH, PERMANENT DISABILITY, OR PARALYSIS OF, ANY PERSON (INCLUDING ME), OR DAMAGE
TO ANY PROPERTY (INCLUDING MINE), (WHETHER OR NOT AS A RESULT OF THE NEGLIGENCE OF
ANY OR ALL OF THE RELEASEES) RESULTING FROM, ARISING OUT OF, OR IN CONNECTION WITH
MY PARTICIPATION IN RECREATIONAL ACTIVITIES AND PROGRAMS, AND/OR MY USE OF TOWN
OF KENSINGTON PROPERTY, EQUIPMENT, AND/OR FACILITIES.
III. INDEMNIFICATION. I HEREBY AGREE TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE
RELEASEES FROM AND AGAINST ANY CLAIM, CAUSE OF ACTION, LIABILITY, OR JUDGMENT
(INCLUDING WITHOUT LIMITATION, LEGAL FEES ASSOCIATED WITH DEFENDING SUCH CLAIM),
RESULTING FROM, ARISING OUT OF, OR IN ANY WAY RELATED TO MY PARTICIPATION IN
RECREATIONAL ACTIVITIES/PROGRAMS AND/OR MY USE OF TOWN OF KENSINGTON PROPERTY,
EQUIPMENT, AND/OR FACILITIES.

I have carefully read, understand, and voluntarily sign this Agreement and acknowledge that it shall be effective and
binding upon me, my family, my heirs, executors, administrators, and representatives. I agree that if any portion of
this Agreement is held to be invalid, the balance of this Agreement shall continue in full force and effect. I agree that
a photocopy or facsimile copy of this Agreement, if fully executed, shall have the same force and effect as the
original. Nothing in this Agreement shall be construed as a waiver of any statutory or common law immunity or
limitation of liability available to the Town of Kensington, its officials, officers, volunteers, employees, and agents.
 

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