BROOMBALL WAIVER AND AGREEMENT

  1. Assumption of Risk. Having read this form, I am fully aware of the risk and hazards associated with Broomball, and hereby elect to voluntarily participate in Broomball. I voluntarily assume full responsibility for any risks of loss property damage or personal injury, including death, which may be sustained by me as a result of participating in Broomball.
  2. Warranty of Physical Fitness. I warrant that I am physically fit and in a condition that will allow me to participate fully in Broomball. It is recommended you maintain medical insurance that covers me for accidents and illnesses while I am participating in Broomball. I assume full responsibility for payment of medical expenses not covered by my insurance incurred as a result of my participation in Broomball
  3. Indemnification. I agree to indemnify and hold harmless Fairfax Ice Arena against any loss, liability, damage or costs, including court and attorneys’ fees, that Fairfax Ice Arena may incur arising from my involvement in Broomball.
  4. Liability Release. I agree and understand that this release agreement is binding upon my heirs, executors, administrators, assigns and legal representatives: that this agreement release all owners, directors, officers, shareholders, employees, agents, successors, assigns and legal representatives of Fairfax Ice Arena; that this release agreement is to be governed by the laws of Virginia.
  5. If broomball participant does not have their own helmet, Fairfax Ice Arena has a limited supply of helmets available at no charge. Participant should thoroughly inspect these helmets and use at own their risk.
  6. The use of helmets on the ice does not eliminate the possibility of serious injuries as stated above.
  7. Helmets are mandatory for everybody that is on the ice for Broomball!
  8. If you feel that playing broomball is unsafe please contact the group leader (individual that scheduled broomball event) and if they can not be found see the manager on duty, who will make every effort to locate leader.
  9. “I agree not to be under the influence of alcohol or other intoxicants while on the ice”. Even a slight impairment of coordination increases the risk of injury to others as well as myself.
  10. I give full permission to Fairfax Ice Arena to use any broomball photographs and/or video taken of me while participating in broomball for publicity, security or advertising purposes.

In signing this Agreement, I acknowledge that I have read this Release Agreement, understand it, and agree to be bound by its terms. I further acknowledge that I sign this Release Agreement voluntarily and I am at least 18 years of age or if under 18 that I am parent or legal guardian of below named minor.

Participants Name: ______(Please Print)

Parent or Legal Guardian: ______(Please Print)

Signature: ______

Date______