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I, (“Participant”), acknowledge that I have voluntarily applied to participate in the (ENTER DESCRIPTION OF ACTIVITIES, WHICH PARTICIPANT WILL ENGAGE IN BELOW)

I AM VOLUNTARILYPARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE  INVOLVEMENT, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN.

 

I verify this statement by placing my initials below:

I forever release the Burlington COA, the State, the County, the Lessor, any fair affiliated organization, and their respective directors, officers, employees, volunteers, agents, contractors, and representatives (collectively “Releasees”)

from any and all actions, claims, or demands that I, my assignees, heirs, distributes, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to (i) my participation in these activities, (ii) the negligence or other facts, whether directly connected to these activities or not, and however caused, by any Releasee, or

(iii) the condition of the premises where these activities occur, whether or not I am then participating in the activities. I also agree that I, my assignees, heirs, distributes, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE BURLINGTON COA, THE STATE, THE COUNTY, AND THE LESSOR, AND SIGN IT OF MY OWN FREE WILL.

If Signed by Parent or Guardian: I verify that the dangers of the activities and the significance of this Release and Waiver were explained to the Participant and that the Participant understood

them.

Executed at, Massachusetts on, 

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IF YOU ARE UNDER 18 YEARS OF AGE, YOU AND YOUR PARENT OR

GUARDIAN MUST SIGN AND INITIAL THIS FORM WHERE INDICATED

© 2024 by Friends of Indian Senior Citizen's Organization. All rights reserved.

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