RELEASE AND WAIVER OF LIABILITY
ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
Triple Canopy Ranch, 16950 County Road 630, Lake Wales, FL 33898
Full Name: ___________________________________
Physical Address: _________________________________________________________________________
Email Address: _______________________________
Event / Activity: CountryFlo Music & Camping Festival
Applicable Date Range: October 28, 2016 - January 1, 2017
*** READ THIS CAREFULLY – IT AFFECTS YOUR LEGAL RIGHTS ***
In consideration for being permitted to enter, attend any event within, use any of the facilities on, or participate in
any activity held at the PREMISES (the PREMISES being anywhere on the property of Triple Canopy Ranch), the
PARTICIPANT (meaning, you and any persons for whom you are legally responsible), on behalf of himself/herself
and his/her personal and legal representatives, assigns, heirs and next of kin agrees as follows:
1. ACKNOWLEDGEMENT AND ASSUMPTION OF THE RISKS. PARTICIPANT acknowledges that there
are risks of property damage, bodily injury and even death associated with attending events and participating in
various activities on the PREMISES, including, but not limited to, dangers related to uneven and/or unstable
terrain, unmarked and/or unknown hazards, ditches, staging and lighting equipment, tents and other temporary or
permanent structures, docks, bridges, fencing, bodies of water, camping, fire, animals, trees, weather and other acts
of nature, vehicle traffic, unmarked routes of travel, using amusement apparatus, such as bounce houses and slides,
loud music, the conduct of other persons, and other known and unknown risks. By entering and/or using the
PREMISES, the PARTICIPANT assumes such risks and agrees not to participate in any event or activity if
PARTICIPANT is unfit to do so or impaired in any way, e.g., due to the influence of drugs or alcohol, the inability
to understand and/or follow instructions (if any), being pregnant, a physical or mental impairment, or other
permanent or temporary disability.
2. RELEASE, WAIVER OF LIABILITY AND COVENANT NOT TO SUE. PARTICIPANT, on behalf of
himself/herself and his/her personal and legal representatives, assigns, heirs and next of kin, releases, waives any
liability of, and agrees not to sue (a) Lucky Dick Promotions, LLC, its owners, members, officers, directors,
operators, employees, agents, representatives, contractors, insurers, successors, affiliates, and subsidiaries; and (b)
the owners, operators, promoters, producers, service providers, lessors, lessees, sponsors, and advertisers of the
PREMISES and/or the events and activities that are held on the PREMISES (collectively the “RELEASED
PARTIES”), from and for any and all claims, property losses, personal injuries, expenses, and damages of any kind
arising out of or related to PARTICIPANT’s attendance or participation in any event or activity on the
{00342899.DOCX /2 } 1 PREMISES. THIS RELEASE, WAIVER OF LIABILITY, AND COVENANT NOT TO SUE APPLIES EVEN TO
THOSE CLAIMS, INJURIES, LOSSES, AND DAMAGES THAT ARISE FROM THE NEGLIGENCE OF THE
RELEASED PARTIES.
3. INDEMNIFY, DEFEND AND HOLD HARMLESS. PARTICIPANT agrees to indemnify, defend and hold
harmless the RELEASED PARTIES, individually and collectively, against all claims, demands, and lawsuits,
including all associated losses, liabilities, attorney’s fees, and other expenses, asserted by a third-party that arise out
of or relate in any way to PARTICIPANT’S conduct associated with an event or activity on the PREMISES (a
“THIRD-PARTY CLAIM”).
PARTICIPANT may settle or otherwise compromise any THIRD-PARTY
CLAIM at his/her discretion, so long as PARTICIPANT pays all expenses, damages, and losses incurred by the
RELEASED PARTIES and secures a release or the equivalent for all potential claims, damages, and expenses that
the RELEASED PARTIES may incur.
4. PAY FOR ANY DAMAGE. PARTICIPANT agrees to pay the reasonable cost to repair, replace or otherwise
address any damage he/she causes to the PREMISES or any facility, structure, or property thereon.
5. USE OF LIKENESS. While attending or participating in a public event or activity on the PREMISES,
PARTICIPANT may be photographed or otherwise recorded.
PARTICIPANT agrees that Lucky Dick
Promotions, LLC, its successors and assigns, may use your name and/or likeness, whether in photographic, video or
other form, WITHOUT NOTICE OR COMPENSATION TO YOU, for purposes of promoting or advertising the
PREMISES and/or the events and activities (and the sponsors and promoters related thereto) held or to be held at
the PREMISES.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND AND AGREE TO BE BOUND BY ITS TERMS,
RECOGNIZE THAT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT
FREELY AND VOLUNTARILY.
___________________________________________________
PARTICIPANT SIGNATURE
_______________________________________
SIGNATURE OF PARENT/GUARDIAN IF
PARTICIPANT IS UNDER 18 YEARS OLD {00342899.DOCX /2 } 2