Parks & Centers Assumption of Risk and Waiver of Liability

Name of event*

Date of event*

In consideration of being allowed to participate in the special interest event listed above, at park/center, I, the undersigned acknowledge, appreciate, and agree that:

There is a risk of injury from the activities involved in this program, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of injury does exist even when these activities are conducted in accordance with all such rules*

I agree

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCY OF OTHERS, and assume full responsibility for my participation*

I agree

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 immediate attention of the nearest official immediately*

I agree

I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE AND HOLD HARMLESS THE HILLSBOROUGH COUNTY BOARD OF COUNTY COMMISSIONERS, their officers, officials, agents and/or employees ("Releasees"), WITH RESPECT TO ANY AND ALL CLAIMS FOR INJURY, DISABILITY, DEATH, or loss or damage to person or property, EVEN IF ARISING FROM THE NEGLIGENCE OF OTHERS*

I agree

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK, AGREEMENT, I FULLY UNDERSTAND ITS TERMS AND I ALSO UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I SIGN FREELY AND VOLUNTARILY.*

I agree

Is the person participating under the age of 18 at at the time of registration?*

Yes No

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 Releases, and, for myself, my heirs, assigned, and next of kin, I release and agree to indemnify the Releases, from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF OTHERS, to the fullest extent permitted by law. I agree that any photographs taken of me on this activity may be used to publicize the Hillsborough County Conservation and Environmental Lands Management Department. *

I agree

Name of person signing the form (participant if over 18, or parent/guardian if participant is under 18 years of age)*

First Name

Last Name

Participant's Name (under 18 year's old)*

First Name

Last Name

Phone of person signing the form*

Signature (participant if over 18, or parent/guardian if participant is under 18 years of age)

[clear]

Use your mouse or finger to draw your signature above

Date*

Do you want to receive a confirmation email with a copy of your responses?*

Yes No

Email for where to send confirmation and copy of responses*