TOWN OF DAVIE

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TOWN OF DAVIE PARKS AND RECREATION DEPARTMENT

PROGRAM REGISTRATION FORM

GENERAL RELEASE

THIS AGREEMENT WAIVES LEGAL RIGHTS, PLEASE CONSULT AN ATTORNEY lF YOU HAVE ANY QUESTIONS.

The UNDERSIGNED PARTICIPANT and/or his guardian, in consideration for the Town of Davie through its Recreation Division for providing facilities, instruction and supervision while attending any event, scheduled or planned by the Town of Davie does hereby:

I) Assume all risk of possible damage or injury involved through participation in any activity planned by the Town or coordinated by the Town with any other person or entity.

2) Request permission to participate in the activity with full knowledge that said activity could result in permanent damage or injury to me.

3) Agree to release, indemnify and hold harmless the Town of Davie and/or its departments or agents, officers, officials and employees from liability resulting from my participation in said activity, including the Town of Davie's gross negligence.

4) Specifically agree and acknowledge that any photos, images or videos of my child taken during said activity shall be the sole property of the Town of Davie and as such, the Town shall utilize any and all photos, images or videos taken of my child for any purposes deemed appropriate by the Town of Davie, including, but not limited to, brochures, documents, leaflets, posters, Town Website, Davie TV and any and all approved Town media. No other person or entity shall have the right to utilize said photos or images for private and/or public uses without the expressed consent of the Town.

Recreation Activity: Skate Park Activity

Location: Bamford Sports Complex

Who will be participating?

Adult  Adult and Children  Children

Participant or Parent/Guardian Information

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.