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HomeMy WebLinkAboutSpooKy_Sports4_10_12.pdfI. .II1 f1 r.1 4 , � 4 ❑ 1 . � 1 � � Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT J Name !l/1 Address ! Z- �` %1�J -ef --6{ (� Z Birth Date . c� C t_t / City, State _ !fit -7 Guardian 1 J ✓� //� -f'f.Z Current Date Home Phone Cell Phone �� j Work Phone Guardian 2 41441-- 441-- AlAi'1-1 S Home Phone _ Cell Phone Work Phone �� l Other Emergency Contact and Phone MEDICAL HISTORY Allergies 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 Signature / Date 10)1/11Z Signat6r 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 —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 l L Jlr�' ,� ®G� CGf t7 Z Parent or Guardian Signature THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. Bozeman Parks and Recreation De artment PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name _ t�%r- wA �-*6� U r -r" i -_7 0 ( ?� � Qz �''r trwr Address Birth Date 7i' Z� • 0 `Z City, State p•'� Guardian 1 Aitlam �t&yz. Current Date I (_-- Home Phone Cell Phone —1R" HOC 0 Z� ,ork Phone 63Z-3 Guardian 2 \ 1 G V46 Home Phone Cell Phoney b6 �� Work Phone Other Emergency Contact and Phone ewir*_S� MEDICAL HISTORY Allergies Medications c/�� Other Medical Information Preference Information (i.e. please do not give soda, vegetarian, no processed snacks, etc.) �Ltz' 5 k' vvw j 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 charoc.ter 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 Signature / Date ohU (Z Signature Parent or Guardian Signature /'Do 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 i-k e u 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 r the act enu dr'v'rty / vle of the participant and from any costs and shall indemnify and hold harmless City o f Bozeman and 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, Parent or Guardian Signature Date I°/i9/ Iv THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. �., i „'►7f It Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name Address \� � F Birth Date 12, ` Z $ " City, State �i92��`�� -J� Guardian l �`�% �� �� Current Date (� I lZ Home Phone Cell Phone gb �40C (Z-Work Phone Lk o 6 114 C 3-z-3 Guardian 2 y k L\V-�E (27 A-t-kcEiL 'r21 q Home Phone Cell Phone �6 �g I Work Phone Other Emergency Contact and Phone 1; T" iAP'1t t-11-i ( t-S& MEDICAL HISTORY Allergies 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. (C I (S W, Parts a Signature / Date Si nature Parent or Guardian Signature / Date Bozeman Parks and Recreation Department Liability Release The undersigned, being at least 21 years of age, her by represents that he or she is the parent or guardian of 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 ( O (9" Parent or Guardian Signature THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. vtr"" Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name (_V? V e.T-4- N �S� Address IS I ��. V D lam. Birth Date ( City, State ,'P->da 1' C�� ' r 1T- 5q -71 q Guardian 1 ( Current Date I ` 1 X — Home Phone Cell Phone ", -q z Work Phone S'ZZ -1 I Guardian 2 Ir Home Phone CellPhone5�-Icf 1 , 3 Work Phone 15K6-2- Other Emergency Contact and Phone .--U hn c7Y- -Doy-)no- MEDICAL HISTORY Allergies in r,--) Y-A� Medications f .I 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 Signature / Date Sign at arent 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 �,' c' Yrt' =� I! d4P 1 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 Pare or Guardian Name, Date to n -i Parent or Guardian Signature THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name YZ�o o o l c��r,�- _ Address Wo C 2— Birth Date L( -- O L('— c)�1 City, State � -9J Current Date Guardian 1 lJ-�— Home Phone (c�) Cell Phone I Work Phone Guardian 2 Home Phone Cell Phone Other Emergency Contact and Phone MEDICAL HISTORY Allergies Medications Other Medical Information Work Phone 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. Bozeman Parks and Recreation Department Liability Release The undersigned, bei g at least 21 years of guardian of the "participant." , hereby represents that he or she is the parent or , hereafter referred to as 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, - arent or Guardian kgnature Date ( Ll-- 17 - /Z THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name Ra_ 1 �=uGL o i 5 Address q bc-KZ n U.) C. Birth Date �5 - a 0 -Oa City, State Guardian 1 i 13holun na —Current Date Home Phone L40 b 5g a -99 4 � Cell Phone qo(o 6,g I- 10/n8dvork Phone '-106 " 50 b ,60 7 U Guardian 2 0 l n Home Phone Cell Phone Work Phone Other Emergency Contact and Phone LCU'L � La.ro c, c'o MEDICAL HISTORY Allergies 'Q�ctSona__Q iot 1 b Lk+4 Medications Other Medical Information 5-'�0 - Za to g mmf- . y 639- Lf 8, 1-6 c 3 Sr8"_all -) s►59�11 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 Signature / Date lehnaLLrn Q,- i D - -) a. 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 I. -I• ILS _ 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, Parent or Guardian Signature Date I d— 1 to - l a THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. \ Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name (1L► -� o 4 S �L ps��. Address a W �Ci� Lc, ► e Birth Date lv O City, State I'C, z z lv', ftAT Guardian 1 K CA r (ZJ\ k Cie Current Date Lo I I* 10L Home Phone Cell Phone 5to a94 1 Guardian 2 S Ce-tt To k nSof\ Home Phone Work Phone 5 I Cell Phone y - 3�(�5 `Mork Phone Other Emergency Contract and Phone a . Nl��ra or- 3 —1)5k �h qiU - 30 kl A' Ll1ic'StCLO� 6gJ_(nygy MEDICAL HISTORY Allergies 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. I_ & Participant Signature / / "In 1111121 �i SignatujWParent or Guardian Signature / Date Bozeman `arks 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 N G�. ����n f ad _ _ 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. ]/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. 1� I CG ' 14 f\ (C)n Participant Name 64'c(� Parent or Guardian Name, Date 101 � L-t I 11�— THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. , / 4 4, L k l � L� ♦�� Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name MAISM 1 ► / tCo t r►J IC t' Address _1 � a S Arai, ,.r S Birth Date ?-/G 10(o City, State M v; MT- Guardian 1 t_[LSSo'_ t Se-6+f I cG r nor Current Date 2 Home Phone Guardian 2 Home Phone Cell Phone G 04 /,S'f b' Work Phone CVO -03A.3 Cell Phone Work Phone Other Emergency Contact and Phone MEDICAL HISTORY Allergies N& Alp �e 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 Signature / Date Signature Parent or Guardian Signature / 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 AelsSn 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. [/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. A41)1.5 In Me- 611/ 4c-L Participant Name / Cl'�s lime i - Parent or Guardian Name, Parent or Guardian Signature Date THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. R „ � � 4 ♦ �ttII _ Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT r Name Address E20 Birth Date ''V City, State11 5T77 r� Guardian 1 Current Date i-Z-- Home Phone Cell Phone ork Phone Guardian 2 06Y��'e7;1 0��� Home Phone Cell Phon clWork Other Em rqency Contact and Phone PEI_ L • MEDICAL HISTORY Allergies Medications Medical Information VAA0V_-� 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 Parent or Guardian Signature / Date Bozeman Parks and Recreation Department Liability Release The undersigned, b ' g at least 21 years of age ereby represents that he or she is the parent or guardian of 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. El" C� Participant Name Parent or Guardian Name, Parent or Guardian Signature Date THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGREEMENT Name C" l Ca, DCLJn NeX_"1() Address 1,q 1 `'f I Z r 66 Y1 Ct ' Birth Date 3 / 1, - C) 4- City, State _3o7_Ma_Q , OCT Guardian 1 � C" le_r 0 "red-�n Current Date LD - L'I —I 2 Home Phone Cell Phone 'J4?-1S3(0 Work Phone Guardian 2 "i A-c k ( J f Yl Home Phone aZTLk��-a -�1'i Cell Phone 555 -10;Lb Work Phone Other Emergency Contact and Phone KO, (eV\ C'` cov\rc-)� MEDICAL HISTORY Allergies Medications k 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 Signature / Date rj::� ..VL�Lo, Signa re 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 CsrraAnc-rvn i )V- 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 Pl VJ.e-r4-on Parent or Guardian Name, Date L b - l'1- l2— Parent or Guardian Signature THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM. Bozeman Parks and Recreation Department PARTICIPANT INFORMATION, MEDICAL RELEASE, VEHICLE HOLD HARMLESS AGRREEElMENT Name �OriQ,� e�!^, A ddress 4g1� Z r.Sb1Y1 JT Birth Date to _(Xe City, State '7k�>OLr Guardian 1 �'Yl� OJ.e r OVA Current Date Home Phone & Tg -a'akLf Cell Phone 5 163 (o Work Phone Guardian 2 r. Home Phone d��a� Cell Phone �J�rJ �i�a� Work Phone Other Emergency Contact and Phone . Kace-n D c ofN o or a 0� -b MEDICAL HISTORY Allergies Medications 1� /k 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 Signature / Date - l`1 -1a- Signc#Ure Parent or Guardian Signature / Date Bozeman Parks and Recreation Department Liability Release The undersigned, bb�"at least 21 ears of age, hereby represents that he or she is the parent or guardian of J Or10.Sf q--CAQ✓) 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. .Jonas Participant Name 1IfaAe� J, 4"'--0�- Parent or Guardian Name, Parent or Guardian Signature Date[ D —1 l ,- (C/ THIS IS A RELEASE OF LIABILITY. PLEASE READ CAREFULLY BEFORE SIGNING OR ENGAGING IN THIS ACTIVITY / PROGRAM.