Church on the Ridge “Turkey Bowl 2016” Football Game
Hold Harmless Agreement and Assumption of Risk Statement
by Participant and/or Responsible Party
Participant Last Name ________________________________
First Name ____________________________________
Date of Birth _____________________ Home Phone ______________________ Mobile Phone ____________________
Mailing Address: Street _________________________________________________________________________
City ________________________________ State __________ Zip _______________________
Emergency Contact
Name_______________________________________ Phone ____________________________
Participant with ________Church on the Ridge ‘Turkey Bowl 2016’ Football Event_________
I am an adult participant or the parent of a minor student I agree, for myself and on behalf of the minor student for whom I sign,
as follows:
I, ___________________________________, acknowledge and agree that I or my child is participating in a football game, otherwise
known as the ‘turkey bowl’, hosted by Church on the Ridge. I fully understand and agree that there is the possibility of an accident or
other physical injury and I agree to assume the risk of such injury and further agree that Church on the Ridge shall have no
responsibility or liability in the event that I or the minor child for whom I am responsible, should suffer(s) any injury or harm.
I declare that (I am) / (the minor child for whom I am responsible is) in good physical health and is able without reservations or
limited conditions to physically withstand and cope with the indicated rigors of this program.
Initial __________
I understand & acknowledge that the description above of the inherent risks of Church on the Ridge activities is not complete and
that other, including unknown or unanticipated, risks, inherent and otherwise, may result in property loss, injury, illness or death. I
acknowledge that my participation in the Turkey Bowl 2016 Football game is purely voluntary, and I wish to participate in spite of
and with knowledge of the inherent and other risks involved. I acknowledge and assume the inherent risks described above and all
other inherent risks of my activity. In addition, except for an injury or other loss which occurs on lands whose rules or regulations
prohibit my doing so as a matter of law, I expressly assume ALL risks of my activity with Church on the Ridge’s football game
(Turkey Bowl 2016), inherent or otherwise, and whether or not described above.
Initial __________
Agreement of Release and Indemnity:
On behalf of myself and any minor child for whom I sign, I hereby release and hold harmless Church on the Ridge and its owners,
directors, officers, employees, contractors and other agents (each a “released party”) from all liabilities, injuries, damage, causes of
action and other agents claims, obligations, costs, losses and all other legal responsibilities (collectively, “claims”) suffered by me or
such minor child and arising from participation in any activity of church on the ridge unless such claim is caused by the gross
negligence, malice or willful misconduct of the released party against whom the claim is brought. I specifically agree not to institute
or cooperate with any claim in violation of the foregoing sentence. I further agree to indemnify and defend church on the ridge or
any other released party against any claim that may be brought against it by any person is such claim is attributable to any of my or
my minor child’s actions or failure to act, is such actions or failure to act constituted gross negligence, malice or willful misconduct
on the party of my child or me.
The participant has read the page and understands and voluntarily agrees to its terms, which shall be binding upon them, their
heirs, estate, executors and administrators. The agreement may be modified only in writing.
________________________________
_____ / _____ / ____
Participant Signature (if participant is 18 yrs or older)
Date
________________________________
_____ / _____ / ____
Parent/Guardian Signature (if participant is a minor)
Date