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HomeMy WebLinkAboutBikes_Boulders.2_9_12.pdfVEHICLE USE RELEASE Parent hereby authorizes the Bozeman Parks and Recreation Department and / or their named staff, and official volunteers to transport the above named participant in a vehicle owned and insured by the City of Bozeman and admits full knowledge of risk and dangers inherent in riding in this vehicle. Parent specifically indemnifies and holds harmless the Bozeman Parks and Recreation Department, staff and volunteers from all injuries, claims, demands, actions, suits, costs (Including attorney's fees), and liabilities of any character whatsoever involving or relating to any and all harm, ' njury or damage suffered by the above named participant arising out of the parfci nt's pre e in a vehicle owned by the City of Bozeman. l / /" 5 -/ / Y Participant Signature / Date Signature Parent or qu�rdian Signature / Date Bozeman Parks and Recreation Department Liability Release The undersigned, eM at east 21 year of age, hereby represents that he or she is the parent or guardian of ti ice. hereafter referred to as the "participant." Further, the undersigned warrants and represents the participant is in good health and there are no special problems associated with the participant and the undersigned has left no special instructions regarding the participant which have not been listed on the registration form. I /we understand and accept the fact the City of Bozeman Recreational activities in its various forms is a HAZARDOUS sport which could have inherent dangers and risks. I /we realize injuries can occur and are a common and ordinary occurrence in activity participation. I /we agree, as a condition of being allowed to participate in Bozeman Parks and Recreation Department activities, I /we freely accept and voluntarily ASSUME ALL RISKS OF PERSONAL INJURY or property damage which results in any way from conditions on or about the premises and facilities, the operation of the facilities or in the course of travel to or from any such program, or activities in the area. I /we freely accept the full responsibility for any and all damage or injury of any kind which may result and agree to indemnify and hold harmless City of Bozeman, and their subsidiaries, their affiliates, and employees acting officially otherwise harmless for any claim, demand actions or causes of action arising out of or on account of any injury or damage to said participant or participant's property. The participant authorizes authorized personnel to call for medical care for the participant or to transport the participant to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed for the participant. The undersigned agrees upon transporting of the participant to any such medical facility or hospital that City of Bozeman shall not have any further responsibility for the participant. Further, the participant / guardian agrees to pay all costs associated with such medical care and related transportation for the participant and shall indemnify and hold harmless City of Bozeman and the activity / venue of and from any costs incurred therein, as provided in the preceding paragraph. This release shall be binding upon the assignees, surrogates, distributees, heirs, next of kin, executors, and administrators of the undersigned and may be pled by Bozeman Parks and Recreation Department and the activity/ program/ venue as a complete bar and defense against any claim, demand, action or cause of action by or on behalf of the undersigned. I /WE HAVE CAREFULLY READ AND UNDERSTOOD THE TERMS OF THIS RELEASE AGREEMENT. I /WE ARE SIGNING IT FREELY AND REALIZE IT IS BINDING UPON MYSELF, MY HEIRS, AND ASSIGNS, AND IN THE EVENT I AM SIGNING IT ON BEHALF OF MY MINOR, I HAVE FULL AUTHORITY TO DO SO, REALIZING ITS BINDING EFFECT ON THEM AS WELL AS MYSELF. Further, full permission is hereby given to use any photographs or movies of said participant taken during an activity or program for any purpose in promoting programs / activities / events of City of Bozeman. Participant Name Date Parent or Guardian Signature THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. iAN Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name E11fi� off} Address 2 qM Pam -fY _ro A a Birth Date ®�P `► (�{-I City, State P -)Av 1Yl�f °I i Guardian 1 V- rJWVi1A Current Date I I SI 12 Home Phone Cell Phone 2,k'' �0 %1 (o D Work Phone Guardian 2 ' k YA Home Phone Cell Phone'DS\ 0-7`50 Work Phone Other Emergency Contact and Phone \K�tv m/-' � upj� Q. �'- MEDICAL HISTORY Allergies Medications Other Medical Information V--,/Rvlo 10 N Lf Preference Information (i.e. please do not give soda, vegetarian, no processed snacks, etc.) MEDICAL RELEASE Parent hereby authorizes the Bozeman Parks and Recreation Department and / or their named staff, and official volunteers to secure any emergency related hospital, medical, dental, or surgical care, treatment and /or procedures for the above named participant. Parent also consents in the event of injury to the participant, staff or volunteers can sign for participant to receive care, treatment and /or procedures under the instructions and directions of the licensed physicians on call at the emergency room of the nearest hospital or emergency facility. The staff /volunteers shall notify parent /guardian at the earliest possible time during or after care, treatment, and /or procedures. Parent knowingly and voluntarily consents in advance to such care, treatment, and /or procedures to encourage physicians and coaches and /or procedures. Parent specifically indemnifies and holds harmless the Bozeman Parks and Recreation Department, staff and volunteers from any and all costs arising out of such care, treatment, and /or procedures. VEHICLE USE RELEASE Parent hereby authorizes the Bozeman Parks and Recreation Department and / or their named staff, and official volunteers to transport the above named participant in a vehicle owned and insured by the City of Bozeman and admits full knowledge of risk and dangers inherent in riding in this vehicle. Parent specifically indemnifies and holds harmless the Bozeman Parks and Recreation Department, staff and volunteers from all injuries, claims, demands, actions, suits, costs (Including attorney's fees), and liabilities of any character whatsoever involving or relating to any and all harm, injury or damage suffered by the above named participant arising out of the participant's presence in a vehicle owned by the City of Bozeman. Signature / Date n Signature / Date Bozeman Parks and Recreation Department Liability Release The undersigned, being at least 21 years of age, hereby represents that he or she is the parent or guardian of oNA hereafter referred to as the "participant." Further, the undersigned warrants and represents the participant is in good health and there are no special problems associated with the participant and the undersigned has left no special instructions regarding the participant which have not been listed on the registration form. I /we understand and accept the fact the City of Bozeman Recreational activities in its various forms is a HAZARDOUS sport which could have inherent dangers and risks. I /we realize injuries can occur and are a common and ordinary occurrence in activity participation. I /we agree, as a condition of being allowed to participate in Bozeman Parks and Recreation Department activities, I /we freely accept and voluntarily ASSUME ALL RISKS OF PERSONAL INJURY or property damage which results in any way from conditions on or about the premises and facilities, the operation of the facilities or in the course of travel to or from any such program, or activities in the area. I /we freely accept the full responsibility for any and all damage or injury of any kind which may result and agree to indemnify and hold harmless City of Bozeman, and their subsidiaries, their affiliates, and employees acting officially otherwise harmless for any claim, demand actions or causes of action arising out of or on account of any injury or damage to said participant or participant's property. The participant authorizes authorized personnel to call for medical care for the participant or to transport the participant to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed for the participant. The undersigned agrees upon transporting of the participant to any such medical facility or hospital that City of Bozeman shall not have any further responsibility for the participant. Further, the participant / guardian agrees to pay all costs associated with such medical care and related transportation for the participant and shall indemnify and hold harmless City of Bozeman and the activity / venue of and from any costs incurred therein, as provided in the preceding paragraph. This release shall be binding upon the assignees, surrogates, distributees, heirs, next of kin, executors, and administrators of the undersigned and may be pled by Bozeman Parks and Recreation Department and the activity/ program/ venue as a complete bar and defense against any claim, demand, action or cause of action by or on behalf of the undersigned. I /WE HAVE CAREFULLY READ AND UNDERSTOOD THE TERMS OF THIS RELEASE AGREEMENT. I /WE ARE SIGNING IT FREELY AND REALIZE IT IS BINDING UPON MYSELF, MY HEIRS, AND ASSIGNS, AND IN THE EVENT I AM SIGNING IT ON BEHALF OF MY MINOR, I HAVE FULL AUTHORITY TO DO SO, REALIZING ITS BINDING EFFECT ON THEM AS WELL AS MYSELF. Further, full permission is hereby given to use any photographs or movies of said participant taken during an activity or program for any purpose in promoting programs / activities / events of City of Bozeman. Participant Name Parent or Guardian Name, Date q I Parent or Guar an Signature THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. . r. Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name G ra.60_M () V e,r- k-nV_\ Address 41-1 l `-k �r� slc � t\ S�-- Birth Date - `- of 7 - o 4 /� City, State �o ZQ..(v� OLY-' . M -T Guardian 1 � en..:�Vw_c uye.r` n Current Date 9-1L+- I ;;L- Home Phone �.,y+- a-?iq Cell Phone 1 g0-Lf5%- -0(P!3 Work Phone Guardian 2 ►`'i. t"Ir �P_. C)vet +nr\ Home Phone Cell Phone 5ct5-i 0 a-D Work Phone Other Emergency Contact and Phone KcLreJn ©` COvw\^ r 40(o -P R- 03 7 Co MEDICAL HISTORY Allergies ons t-�lp'. Other Medical Information Preference Information (i.e. please do not give soda, vegetarian, no processed snacks, etc.) MEDICAL RELEASE Parent hereby authorizes the Bozeman Parks and Recreation Department and / or their named staff, and official volunteers to secure any emergency related hospital, medical, dental, or surgical care, treatment and /or procedures for the above named participant. Parent also consents in the event of injury to the participant, staff or volunteers can sign for participant to receive care, treatment and /or procedures under the instructions and directions of the licensed physicians on call at the emergency room of the nearest hospital or emergency facility. The staff /volunteers shall notify parent /guardian at the earliest possible time during or after care, treatment, and /or procedures. Parent knowingly and voluntarily consents in advance to such care, treatment, and /or procedures to encourage physicians and coaches and /or procedures. Parent specifically indemnifies and holds harmless the Bozeman Parks and Recreation Department, staff and volunteers from any and all costs arising out of such care, treatment, and /or procedures. VEHICLE USE RELEASE Parent hereby authorizes the Bozeman Parks and Recreation Department and / or their named staff, and official volunteers to transport the above named participant in a vehicle owned and insured by the City of Bozeman and admits full knowledge of risk and dangers inherent in riding in this vehicle. Parent specifically indemnifies and holds harmless the Bozeman Parks and Recreation Department, staff and volunteers from all injuries, claims, demands, actions, suits, costs (Including attorney's fees), and liabilities of any character whatsoever involving or relating to any and all harm, injury or damage suffered by the above named participant arising out of the participant's presence in a vehicle owned by the City of Bozeman. PartiLipbnt Signature / Date Signature Parent or Guardian Signature / Date Bozeman Parks and Recreation Department Liability Release The undersigned, being at least 21 years of age, hereby represents that he or she is the parent or guardian of C7-y- hereafter referred to as the "participant." Further, the undersigned warrants and represents the participant is in good health and there are no special problems associated with the participant and the undersigned has left no special instructions regarding the participant which have not been listed on the registration form. I /we understand and accept the fact the City of Bozeman Recreational activities in its various forms is a HAZARDOUS sport which could have inherent dangers and risks. I /we realize injuries can occur and are a common and ordinary occurrence in activity participation. I /we agree, as a condition of being allowed to participate in Bozeman Parks and Recreation Department activities, I /we freely accept and voluntarily ASSUME ALL RISKS OF PERSONAL INJURY or property damage which results in any way from conditions on or about the premises and facilities, the operation of the facilities or in the course of travel to or from any such program, or activities in the area. I /we freely accept the full responsibility for any and all damage or injury of any kind which may result and agree to indemnify and hold harmless City of Bozeman, and their subsidiaries, their affiliates, and employees acting officially otherwise harmless for any claim, demand actions or causes of action arising out of or on account of any injury or damage to said participant or participant's property. The participant authorizes authorized personnel to call for medical care for the participant or to transport the participant to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed for the participant. The undersigned agrees upon transporting of the participant to any such medical facility or hospital that City of Bozeman shall not have any further responsibility for the participant. Further, the participant / guardian agrees to pay all costs associated with such medical care and related transportation for the participant and shall indemnify and hold harmless City of Bozeman and the activity / venue of and from any costs incurred therein, as provided in the preceding paragraph. This release shall be binding upon the assignees, surrogates, distributees, heirs, next of kin, executors, and administrators of the undersigned and may be pled by Bozeman Parks and Recreation Department and the activity/ program/ venue as a complete bar and defense against any claim, demand, action or cause of action by or on behalf of the undersigned. I /WE HAVE CAREFULLY READ AND UNDERSTOOD THE TERMS OF THIS RELEASE AGREEMENT. I /WE ARE SIGNING IT FREELY AND REALIZE IT IS BINDING UPON MYSELF, MY HEIRS, AND ASSIGNS, AND IN THE EVENT I AM SIGNING IT ON BEHALF OF MY MINOR, I HAVE FULL AUTHORITY TO DO SO, REALIZING ITS BINDING EFFECT ON THEM AS WELL AS MYSELF. Further, full permission is hereby given to use any photographs or movies of said participant taken during an activity or program for any purpose in promoting programs / activities / events of City of Bozeman. Participant Name B Q 4trA-0 V^V Parent or Guardian Name, Parent or Guardian Signature Date � —l1{ —lam THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. i. ••I',^ � AI a 4� �, Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name JP)fNC_5 0V er --orb Address 14'411+ 'zA. Birth Date &-X9_0(P City, State bozRjnc V1 . { &Z Guardian 1 4ea. I tr (5fcr4_0� Current Date cL - A -1 D__ Home Phone J6-f-9 'L1 Li' cell Phone E!40 -45 6�LW��Mlork Phone Guardian 2 MA�e, L Oy-r_cAriq Home Phone %�'f -�'Zl� Cell Phone 6c(5.1001b Work Phone Other Emergency Contact and Phone MEDICAL HISTORY Allergies Ar- Medications Other Medical Information Preference Information (i.e. please do not give soda, vegetarian, no processed snacks, etc.) MEDICAL RELEASE Parent hereby authorizes the Bozeman Parks and Recreation Department and / or their named staff, and official volunteers to secure any emergency related hospital, medical, dental, or surgical care, treatment and /or procedures for the above named participant. Parent also consents in the event of injury to the participant, staff or volunteers can sign for participant to receive care, treatment and /or procedures under the instructions and directions of the licensed physicians on call at the emergency room of the nearest hospital or emergency facility. The staff /volunteers shall notify parent /guardian at the earliest possible time during or after care, treatment, and /or procedures. Parent knowingly and voluntarily consents in advance to such care, treatment, and /or procedures to encourage physicians and coaches and /or procedures. Parent specifically indemnifies and holds harmless the Bozeman Parks and Recreation Department, staff and volunteers from any and all costs arising out of such care, treatment, and /or procedures. VEHICLE USE RELEASE Parent hereby authorizes the Bozeman Parks and Recreation Department and / or their named staff, and official volunteers to transport the above named participant in a vehicle owned and insured by the City of Bozeman and admits full knowledge of risk and dangers inherent in riding in this vehicle. Parent specifically indemnifies and holds harmless the Bozeman Parks and Recreation Department, staff and volunteers from all injuries, claims, demands, actions, suits, costs (Including attorney's fees), and liabilities of any character whatsoever involving or relating to any and all harm, injury or damage suffered by the above named participant arising out of the participant's presence in a vehicle owned by the City of Bozeman. Participant Signaffire / Date Signature Pdi4--nt or Guardian Signature / Date Bozeman Parks and Recreation Department Liability Release The undersigned, being at least 21 years of age, hereby represents that he or she is the parent or guardian of 2Ei+ - C2V hereafter referred to as the "participant." Further, the undersigned warrants and represents the participant is in good health and there are no special problems associated with the participant and the undersigned has left no special instructions regarding the participant which have not been listed on the registration form. I /we understand and accept the fact the City of Bozeman Recreational activities in its various forms is a HAZARDOUS sport which could have inherent dangers and risks. I /we realize injuries can occur and are a common and ordinary occurrence in activity participation. I /we agree, as a condition of being allowed to participate in Bozeman Parks and Recreation Department activities, I /we freely accept and voluntarily ASSUME ALL RISKS OF PERSONAL INJURY or property damage which results in any way from conditions on or about the premises and facilities, the operation of the facilities or in the course of travel to or from any such program, or activities in the area. I /we freely accept the full responsibility for any and all damage or injury of any kind which may result and agree to indemnify and hold harmless City of Bozeman, and their subsidiaries, their affiliates, and employees acting officially otherwise harmless for any claim, demand actions or causes of action arising out of or on account of any injury or damage to said participant or participant's property. The participant authorizes authorized personnel to call for medical care for the participant or to transport the participant to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed for the participant. The undersigned agrees upon transporting of the participant to any such medical facility or hospital that City of Bozeman shall not have any further responsibility for the participant. Further, the participant / guardian agrees to pay all costs associated with such medical care and related transportation for the participant and shall indemnify and hold harmless City of Bozeman and the activity / venue of and from any costs incurred therein, as provided in the preceding paragraph. This release shall be binding upon the assignees, surrogates, distributees, heirs, next of kin, executors, and administrators of the undersigned and may be pled by Bozeman Parks and Recreation Department and the activity/ program/ venue as a complete bar and defense against any claim, demand, action or cause of action by or on behalf of the undersigned. I/WE HAVE CAREFULLY READ AND UNDERSTOOD THE TERMS OF THIS RELEASE AGREEMENT. I /WE ARE SIGNING IT FREELY AND REALIZE IT IS BINDING UPON MYSELF, MY HEIRS, AND ASSIGNS, AND IN THE EVENT I AM SIGNING IT ON BEHALF OF MY MINOR, I HAVE FULL AUTHORITY TO DO SO, REALIZING ITS BINDING EFFECT ON THEM AS WELL AS MYSELF. Further, full permission is hereby given to use any photographs or movies of said participant taken during an activity or program for any purpose in promoting programs / activities / events of City of Bozeman. MWEA �NNWCM-ell Participant Name Dve-4-1n) - , , , [)'I Parent or Guardian Name, Parent or Guardian Signature Date -l— k —. THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM.