Old Town
Recreation Center
WHERE RECREATION, EDUCATION AND COMMUNITY COME TOGETHER
342 Bennoch Road P.O. Box 273
Stillwater, ME 04489
(207/827-3961) www.oldtownrec.com
Release and Assumption of Risk
There are many dangers and hazards inherent to participants of the Old Town Recreation
Center’s programs because of the nature of the activities involved.
I, _________________________, the legal parent/guardian of __________________________,
agree, in consideration of my child being able to participate in the Old Town Recreation
Center’s program, to accept and assume full responsibility for all harm and injury of every
nature, including death, which may occur to me or which my child may suffer or cause to
others, and for all damages or loss to any personal property owned or damaged by my child
while my child is participating in the program and during all travel and transportation, and in
furtherance thereof, I agree to indemnify, hold harmless, and release the Old Town Recreation
Center, its employees, volunteers, agents, sponsors, and lesser of premises used for program
activities from and against any and all claims, demands, actions or causes of action on account
of damage or loss of personal property, personal injury or death, or the bodily injury, death or
damage to personal property of others caused by my child which may occur or result directly or
indirectly from my child’s participation in the Old Town Recreation Center program and not as a
direct result of any negligent act of the Old Town Recreation Center, its employees, volunteers,
agents, sponsors, and lesser of premises used for program activities.
I voluntarily execute this Release and Assumption of Risk on behalf of myself, my heirs, my
next-of-kin, my personal representative and my estate. I declare that I completely understand
the terms and conditions of this Release and Assumption of Risk by having read it, or having it
read to me.
Assigned and agreed to this __________ day of _________________________, 20_____.
Signature of Parent/Guardian: ________________________________ Date: ______________
(This Release expires 08/31/17)