Acknowledgment and Assumption of Potential Risk Participation Waiver and Release of Liability I wish to participate in a Barton Health activity program. I understand and acknowledge that some of the injuries/illnesses which may result from participating in these activities include, but are not limited to, the following: - Sprains/Strains
- Head and/or back injuries
- Communicable diseases
- Cuts and/or burns
- Fracture
- Paralysis
- Loss of eyesight
- Unconsciousness
- Death
I understand and acknowledge that participation in these activities is completely voluntary. I understand and acknowledge that in order to participate in these activities I fully and voluntarily agree to assume any and all liability and responsibility for any and all potential risks which may be associated with participation in such activities. I affirm that I am physically able to participate in these activities. I understand, acknowledge, and agree Barton and its respective employees, officers, agents and volunteers shall not be liable for any injury or illness suffered by me which is incident to and/or associated with preparing for participating in, or traveling to or from these activities or caused by my participation in these activities. I grant to Barton Health the right to take photographs of me in connection with Barton Health activity programs. I authorize Barton Health to copyright, use and publish the same in print and/or electronically. I agree that Barton Health may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. I acknowledge that I have carefully read this VOLUNTARY ACTIVITIES PARTICIPATION, ACKNOWLEDGMENT AND ASSUMPTION OF POTENTIAL RISK and RELEASE OF LIABILTY FORM and that I understand and agree to its terms. |