RELEASE, WAIVER OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
I, ________________________ (“Participant”), desire to participate in one or more of the following activities (each, an
“Activity”, and collectively, the “Activities”) located in or originating from one or more of Blue Cross and Blue Shield of
Kansas City’s (“BCBSKC”) retail locations or otherwise sponsored or organized by BCBSKC:
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1.
Fitness classes and exercise programs, including, without limitation, yoga classes
Cooking class
Any other participatory program offered or organized by BCBSKC (e.g., bike runs and running programs)
Acknowledgements. Participant understands and agrees as follows:
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It is Participant’s responsibility to assure through a physician that he/she has no medical conditions that would
keep him/her from participating in any Activity, including, without limitation, fitness classes and exercise
programs.
Participant’s participation in any Activity is totally at his/her own risk with full responsibility for his/her own
medical condition.
Participant should not rely on other participants for instruction nor hold them or any Releasees (as defined
below) accountable if information volunteered causes personal injury.
Participant’s participation in Activities is not an entitlement, and Participant’s participation in any Activity may
be limited or suspended at any time.
BCBSKC is not responsible for the security of any personal items Participant may bring into a retail location,
even if they are placed in a locked locker.
2.
Waiver and Release. Participant does hereby release and forever discharge and hold harmless BCBSKC, its
officers, directors, employees, affiliates, agents, contractors, vendors, successors and assigns (collectively, “Releasees”)
from any and all liability, claims, losses and demands of whatever kind or nature, either in law or in equity, arising from or
related to participating in any one or more of the Activities. Participant understands that this Agreement discharges the
Releasees from any liability or claim that the Participant may have against a Releasee with respect to any bodily injury,
personal injury, illness, death, disability, property damage, incidental or consequential damages, punitive damages or
special damages that may result from participating in any one or more of the Activities, whether or not caused by the
negligence of any one or more of the Releasees, other participants in the Activities, or otherwise. This waiver and
release shall be binding upon Participant’s heirs, administrators, executors and assigns.
3.
Medical Treatment. Should Participant be injured or fall while participating in an Activity or while otherwise in or
about a retail location and require medical treatment, Participant agrees that a Releasee may dial 911 and an ambulance
may be called. Any expense resulting from emergency services will be billed to Participant and is Participant’s
responsibility. Participant does hereby release and forever discharge the Releasees from any claim whatsoever which
arises or may hereafter arise on account of any first aid, treatment or service rendered by any person in connection with
participation in any Activity.
4.
Photographic Release. Participant, without entitlement to any compensation, does hereby grant and convey unto
BCBSKC authorization to use in perpetuity, and all right, title and interest in any and all photographic images and video or
audio recordings made by BCBSKC that depict Participant, including but not limited to, any royalties, proceeds or other
benefits derived from such photographs or recordings.
5.
Other. Participant expressly agrees that this Agreement is intended to be as broad and inclusive as permitted by
law. Participant agrees that in the event that any clause or provision of this Agreement shall be held to be invalid by any
court of competent jurisdiction, the validity of the remaining provisions of this Agreement shall continue to be enforceable.
I HAVE READ THIS RELEASE, WAIVER OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND
HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE
BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL
LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
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Participant Printed Name:
Date:
Participant Signature:
Participant Contact Information
Address:
Phone (H):
Phone (M):
Emergency Information
IN case of emergency, please contact:
Name:
Relationship:
Phone:
Address:
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