Special Needs Sports Program Application

* YOU MUST BE A BAYONNE RESIDENT TO PARTICIPATE.








Parental Permission to Participate

I, as the parent and/or legal guardian of the Participant stated above, have given my son/daughter permission to participate in the Special Needs Sports Program. I certify that the Participant is in good health and can take part in all activities without restriction. I fully understand that participation in this event involves serious risks that may result in harm, bodily injury or death.

In the even of an emergency or any injury occurs, I authorize the event staff member(s) to take all proper precautions and actions necessary to treat or otherwise arrange for diagnosis, medical attention and treatment of Participant including, but not limited to, emergency service(s) available at the nearest hospital, if necessary. I understand that my personal insurance coverage will be used in this case or in the event that the participant is not covered by any medical health insurance, that I will be required to make other financial arrangements directly with the health care facility or health care provider in the event that my child is transported to a health care facility or treated in a health care facility by a health care provider.

I, for myself and on behalf of the Participant hereby release, indemnify and hold harmless CITY OF BAYONNE and any of its agents, directors, employees, volunteers, staff, officials, agents, and/or representatives, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of the premises used to conduct the event against any and all claims, costs, expenses, damages, moneys and expenses that may be asserted against the CITY OF BAYONNE.

I acknowledge and agree that CITY OF BAYONNE retains the right to use photographs and videos taken of the event participants for publicity and advertising purposes.

I HAVE READ THIS RELEASE OF LIABILITY, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY EXECUTING THIS DOCUMENT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT WHATSOEVER.



* required