Liability Release/Waiver
Every Participant must have a completed and signed release form prior to participating.
Name:
(Minor/Participant – Please PRINT clearly)
Name:
(Parent/Guardian – Please PRINT clearly)
Address:
(Minor/Participant – Please PRINT clearly)
City
State
Zip Code
Cell Phone: (
)
(Parent/Guardian – Please PRINT clearly)
Email Address:
(Parent/Guardian – Please PRINT clearly)
DISQUALIFICATIONS: ______________________________ (hereinafter “Company”), reserves
the right to disqualify and/or exclude, in our sole and absolute discretion, any individual from
any participation for any reason or for no reason at all, including without limitation, violation of
any portion of these rules, or tampering with the entry process or the audition process. We also
reserve the right to change the rules and procedures at any time..
RELEASE OF LIABILITY/WAIVER: The above listed parent or legal guardian of the above
listed minor (hereinafter “Minor”) hereby grants the permission necessary to allow Minor to
participate in the _____________________________ to be conducted by the Company. I, in my
own behalf and on behalf of Minor, further agree to release and to hold harmless the Company,
the location on whose premises the ____________________________ will occur (hereinafter
the “Location”) the affiliates of the Company, and the respective directors, officers,
representatives, members, agents and employees of the Company, Sponsors and their respective
affiliates from any and all liability, whether caused by the negligence or otherwise for any claim,
judgment, loss, liability, cost and expenses (including, without limitations, attorney’s fees and
costs) arising out of or connected with the ____________________________, including any
claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or
death) that Minor may incur or sustain during the ___________________________, all activities
associated with the ____________________ and while traveling to and from the site for the
___________________________ whether or not the _____________________ actually occurs.
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Liability Release/Waiver
I further expressly agree to indemnify and hold harmless any heirs, successors, assigns,
executors and administrators against loss from any further claims, demands or actions that may
subsequently be brought by Minor or by any other persons on the account of damages of any
character resulting to Minor in any way from the foregoing activities. I, in my own behalf and on
behalf of Minor, hereby warrant that I have read this Liability Release/Waiver Form in its
entirety and fully understand its contents. I, in my own behalf and on behalf of Minor, am aware
that this Liability Release/Waiver Form releases from liability and contains an acknowledgement
of my voluntary and knowing assumption of the risk of injury or illness. I, in my own behalf and
on behalf of Minor, further acknowledge that nothing in this Liability Release/Waiver Form
constitutes a guarantee that the ______________________________ will occur. I, in my own
behalf and on behalf of Minor, have signed this document voluntarily and of my own free will.
Signature:
(Parent/Guardian)
Date:
Relationship to Minor:
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