Vance Elementary School
Field Day
5/20/2016
Assumption of Risk & Release Form
In consideration of the undersigned or the undersigned’s child or children, as the case may be, being allowed to participate, ride, play in or on and use, in any way, the play units and related events and activities, hereby acknowledge, appreciate and agree that:
1.The risk of physical injury from the activities involved in using, riding, and/or playing in or on a Play Unit or participating in related activities and programs is significant, including the potential for sprains, broken bones, cuts, serious or permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury or death to us does exist; and
2.Knowing the harmful risks associated with riding, using, and/or playing in or on a Play Unit, I voluntarily assume any and all risk, both known, including those listed above, and unknown, of property damage or bodily injury, including death. I assume full responsibility for myself and my child’s or my children’s riding, using, and/or playing in or on a Play Unit; and
3.I willingly agree to comply with the stated and customary terms and conditions for riding, use and play in or on a Play Unit. This includes, but is not limited to, wearing protective equipment at all times, removing hard, sharp or dangerous objects from my person, such as shoes, buckles, cell phones, and purses, and adhering to the “no flips” rule. If I observe any unusual significant hazard during my use or play in or on a Play Unit, I will remove myself from the Play Unit and bring such to the attention of the nearest official immediately; and
4.I, for myself and on behalf of my child and/or children, heirs, assigns, personal representatives and next of kin, hereby waive, release, indemnify and hold harmless the Tuscaloosa County Board of Education, Vance Elementary School, its Superintendent, directors, trustees, officers, employees, agents, attorneys and/or volunteers (hereafter the “Releasees”) from any and all claims for damages resulting from my or my child’s or my children’s playing in or on or using a Play Unit, and further promise not to sue any of the Releasees to recover damages for injuries or death or property damage caused by or in connection with my playing, my child’s or my children’s playing in or on or using a Play Unit.
I hereby certify, agree, and understand that I am at least 19 years old, that I nor my child or children will engage in rough play in, on or around a Play Unit; that the play units are physically challenging; I certify that neither I nor my child or my children have health impairments or medical conditions which would render our use of such play units unsafe.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY WITHOUT ANY INDUCEMENT. I, FOR MYSELF AND MY CHILD OR MY CHILDREN, WANT TO PARTICIPATE IN THIS HAZARDOUS ENTERTAINMENT AND PLAY. This document is binding for any subsequent events involving the Tuscaloosa County Board of Education and any of its individual schools until further notice.
Participant/Parent/Guardian SignatureDate Signed
Name(s) of Child: ______Teacher:______