NOTICE TO THE MINOR CHILD'S
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 CITY OF HIALEAH 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.
CONSENT TO PARTICIPATE: I am the parent, whether natural or adoptive, or court appointed legal guardian of the minor child identified as the Participant in this Agreement. I have the authority and do hereby give full permission for the Participant to volunteer or take part in the Sports Program, Sports League or Sporting Event (identified above) sponsored or organized by the City of Hialeah. I have instructed the Participant to obey, at all times, all instructions, orders and commands given by the Sports Program, Sports League or Sporting Event supervisors, coordinators, staff, coaches, trainers, directors, volunteers or other authorized representatives, or the designees of any of these, for the City Hialeah. . I also acknowledge that my child's participation in the Activity is in the capacity of a volunteer only. As such, neither my child nor I expect nor will we receive any compensation in return for my child's services as a volunteer.
My minor child is in good health and has no mental or physical condition, ailment or injury (medical or otherwise) which would, in and of itself, or in conjunction with any other circumstance, affect my child's ability to fully participate in the Sports Program, Sports League or Sporting Event (identified above) and have not been advised otherwise by a medical practitioner. My minor child is covered by medical insurance, individually or as part of an organization.
I understand and acknowledge that, although the City of Hialeah may take all reasonable precautions to maintain reasonably safe conditions on its premises and provide for the reasonable care and safety of its employees, volunteers, guests and members of the general public, there are dangers and conditions, known or unknown, which are characteristic of, intrinsic to, or an integral part of the Sports Program, Sports League or Sporting Event, that no reasonable amount of care, caution, prudence or expertise can eliminate, including without limitation, the potential for serious bodily injury, permanent disability, paralysis and loss of life. These risks and dangers may result not only from my minor child's actions, inactions or negligence, but also from the actions, inactions or negligence of others, including other participants, the condition of the premises or the condition of any vehicle or equipment used. I understand and acknowledge that there may be other risks not reasonably known at this time. I am voluntarily allowing my minor child to participate in the Sports Program, Sports League or Sporting Event (identified above) with knowledge of the possible dangers involved. I hereby voluntarily assume and unequivocally accept, on behalf of myself and my minor child, any and all risks of injury or death to my minor child or to any other person which may result from my child's participation in the Sports Program, Sports League or Sporting Event (identified above), regardless of how such injury or death may arise and regardless of who is at fault.
BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD'S RIGHT AND YOUR RIGHT TO RECOVER FROM CITY OF HIALEAH 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 CITY OF HIALEAH HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.
RELEASE OF ALL CLAIMS: I understand and unequivocally agree that by signing this Agreement, I, for myself, my heirs, beneficiaries, estate, executors, administrators, next of kin, and anyone else who might attempt to sue on my behalf, and on behalf of the Participant, Participant's heirs, beneficiaries, parents, guardians, estate, executors, administrators, next of kin, and anyone else who might attempt to sue on Participant's behalf, hereby waive, release, hold harmless, indemnify, covenant not to sue, agree to defend, and forever discharge the City of Hialeah, its officers, elected or appointed, directors, employees, coaches, trainers, counselors, volunteers, agents, attorneys, contractors and all other persons, entities, organizations and corporations affiliated therewith (all of whom constitute the "Released Parties") from any and all kinds of claims, suits, causes of action, damages, losses, liabilities, costs or expenses, including court costs and attorney's fees at all level of proceedings (including appellate level), and any judgments, orders or decrees entered thereon or resulting therefrom, for any personal injury, loss of life, damage to property, or any other liability, loss, cost or expense of any kind (collectively "Claims"), arising out of, resulting from, or relating to my minor child's participation in the Sports Program, Sports League or Sporting Event (identified above).
RELEASE AND CONSENT TO USE PARTICIPANT'S PERSONAL INFORMATION: I hereby authorize and grant full permission to the Released Parties, by any means, whether now known or hereinafter developed, to exhibit, record, reproduce, broadcast, transmit, publish, sell distribute, perform, use and re-use (collectively "Rights"), for any purpose, in any manner, without further notification, authorization, or compensation to me, my minor child or anyone on either of our behalf's, the Participant's name, likeness, biography and any photographs, videotapes, motion pictures, recordings or other record of performance (or any part or parts of my minor child's performance) (collectively "Information") in connection with the Sports Program, Sports League or Sporting Event for publicity, advertising and promotion of the Sports Program, Sports League or Sporting Event, any future activities and any other program, event or activity sponsored or organized by the City of Hialeah. I hereby waive, release, hold harmless, indemnify, covenant not to sue, agree to defend, and forever discharge the Released Parties from any Claims arising out of or in connection with use of the Rights or Information. I, for myself and my minor child, hereby waive any right to inspect or approve any finished product and hereby represent and warrant that no further permission is required for the Released Parties to use the Rights or Information provided herein.
EFFECTIVE PERIOD: This Agreement shall become effective immediately on the date I sign it and shall remain in effect and enforceable by the City of Hialeah and all other Released Parties throughout the entire time period during which my child participates in the Sports Program, Sports League or Sporting Event (identified above) unless I revoke this Agreement in writing. I understand that if I revoke this Agreement my child will not be allowed to participate in the Sports Program, Sports League or Sporting Event.
CONSENT TO TREATMENT: I authorize such physician or medical staff as the City of Hialeah may designate to carry out any medical treatment deemed necessary, or to take the Participant to the emergency room of the nearest hospital for treatment, if necessary.
I acknowledge that this Agreement will be construed broadly and in the light most favorable to the Released Parties to provide waiver, release, indemnity, defense or be held harmless from liability, as set forth herein, to the Released Parties to the maximum extent permitted by law. Any provisions found to be void or unenforceable shall be severed from this Agreement and shall not affect the validity or enforceability of any remaining provisions.
I have read this Agreement, carefully, in its entirety and I fully understand its content. I am 18 years of age or older, of sound mind and body and not under the influence of alcohol, any illicit or prescription drug or medication, or under any other legal disability which may in any way impair my ability to enter into this Agreement. Intending to be legally bound, I have voluntarily signed this Agreement.