Village of Palm Springs, FL

COVENANT NOT TO SUE

In consideration of permission granted my child by the Village of Palm Springs Parks and Recreation Department to participate in the YOUTH ATHLETIC PROGRAM, I hereby agree not to sue the Village of Palm Springs, Florida, Its agents, employees and officers for all claims, demands, actions, judgments, and executions which the undersigned heirs, executors, administrators or assigns may have, or claims to assigns, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by or arising out of, the above described activity.

I hereby request permission for my child to participate in the above described activity with full knowledge the said activity could result in damage or injury to my child. I, the undersigned, have read this covenant and understand all of its terms. I execute it voluntarily and will full knowledge of its significance.

NOTICE TO THE MINOR CHILD'S NATURAL GUARDIAN

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT EVEN IF THE VILLAGE OF PALM SPRINGS USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD'S RIGHT AND YOUR RIGHT TO RECOVER FROM THE VILLAGE OF PALM SPRINGS IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM AND THE VILLAGE OF PALM SPRINGS HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THE FORM.

In witness whereof, I have executed this release at Palm Beach County, Florida on the day and year written below.

MEDICAL CONSENT FOR A MINOR
I / We the below signed parent or lawful guardian does hereby consent to any duly licensed physician or hospital for any necessary emergency treatment on or for my child, if an accident should occur during activity.

I/ We the below signed parent or lawful guardian does hereby consent for the Leisure Services Staff to authorize medical treatment and sign any hospital forms required to permit any hospital treatment, if an accident happens during activity, in the event we cannot be reached at time of injury.

GENERAL PHOTOGRAPHY RELEASE

I hereby authorize the Village of Palm Springs, Florida to use and publish photographs and/or videos taken of me and my name and likeness (hereafter referred to as “Images”), for use in the Village’s print, online and video-based marketing materials, as well as other Village publications. I hereby release and hold harmless the Village from any reasonable expectation of privacy or confidentiality arising out of or associated with the Images. I further acknowledge that I voluntarily consent to all uses and publications of the Images and that I will not receive financial compensation of any type arising out of or associated with the taking, use or publication of the Images. I acknowledge and agree that publication of the Images confers no rights of ownership or royalties whatsoever. I hereby release the Village, its officers, its contractors, its employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party arising out of or in connection with the Images.

THE REGISTRANT HAS READ AND VOLUNTARILY SIGNS THIS AGREEMENT, and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

The contact will be automatically added to the class as a registrant if someone drops out from a full class.