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ZT MOTORS FOOTBALL CAMP EMERGENCY CONTACT, WAIVER OF LIABILITY/HOLD HARMLESS AGREEMENT

DATE: JUNE 17, 2017        LOCATION: Fort Walton Beach High School, 400 Hollywood Blvd SW, Fort Walton Beach, FL 32548

PARTICIPANT'S NAME:

PARENT/EMERGENCY CONTACT INFORMATION

Name:
Rel:
Email:
Address:
City:
State:
Zip:
Phone:

To participate in this camp and in consideration of the below, I hereby RELEASE, WAIVE AND FOREVER DISCHARGE AND COVENANT NOT TO SUE ZT MOTORS OF FORT WALTON, LP, THE GREATER FORT WALTON BEACH CHAMBER OF COMMERCE, OKALOOSA COUNTY SCHOOL DISTRICT OR FORT WALTON BEACH HIGH SCHOOL and their respective officers, servants, agents, volunteers or employees (the "RELEASEE") from any and all liability, claims, demands, or course of action whatsoever arising out of or related to any loss, damage, or injury, including bruises, broken bones, paralysis and even death, that may be sustained by me/my child, or to any property belonging to me/my child, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE, or otherwise.

To the best of my knowledge, I/my child am/is in good physical condition and I am not aware of any physical infirmity which would place me/my child at risk to participate at the camp in any way or that the reasonable accommodation(s) listed below would permit participation at camp. I am fully aware of the risks and dangers associated with the activities. I AGREE TO PARTICIPATE IN/ALLOW MY CHILD TO PARTICIPATE IN A POTENTIALLY DANGEROUS ACTIVITY. I AM AWARE THAT, EVEN IF RELEASEE USES REASONABLE CARE IN PROVIDING THIS CAMP, THERE IS A CHANCE I/MY CHILD MAY BE SERIOUSLY INJURED OR KILLED BY ENGAGING IN THIS CAMP BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE CAMP WHICH CANNOT BE AVOIDED OR ELIMINATED. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me/my child, or any loss or damage to property owned by me/my child, because of participating in the camp's activities WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEE or otherwise, while participating in this camp, or while in, on or upon the property where the camp is being held.

During the period of the camp, I hereby give permission for the staff of Releasee to administer appropriate medical care to me/my child in the occurrence of any accident, illness, or injury, including non-prescription medications or any medications listed herein that I/my child brings to camp in original containers with dosage directives. I will be accountable for any and all charges of medical coverage and treatment provided and not covered by insurance. I/my child has medical insurance and understand this is required for participation at camp.

I further hereby acknowledge, consent and authorize Releasee and/or their coaches, agents, representatives or volunteers to take photographs or digital recordings of me/my child as a participant during this event and further authorize the use or distribution of any image, video or the like related to camp activities. I also authorize Releasee to reveal my/my child's identitytherein or by description text or commentary. I waive any rights, claims or interest and I understand that there will be no financial or other remuneration provided to me/my child.

This waiver of liability, hold harmless agreement and image release shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law and shall be construed in accordance with the laws of the State of Florida. I WAIVE MY/MY CHILD'S RIGHT TO A JURY TRIAL AND WILL LET A JUDGE DECIDE ALL ISSUES RELATING TO THIS AGREEMENT, OR ANY INURY OR DAMAGE ARISING FROM MY/MY CHILD'S ENGAGEMENT AT CAMP.

I ACKNOWLEDGE AND CERTIFY THAT I HAVE READ THIS DOCUMENT THOUROUGHLY, AND ACKNOWLEDGE THAT I FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUSTANTIAL RIGHTS BY SIGNING IT, AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND SIGN IT ON MY OWN FREE WILL.

PARENT/LEGAL GUARDIAN/PARTICIPANT IF 18+ SIGNATURE
DATE/PRINTED NAME

CAMP PARTICPANT MUST HAVE MEDICAL INSURANCE

Insurance Company:  
Insurance Provider/Customer Service Number:  
Policy Number:  
Group Number:  
Name on Policy:  
Relationship to Camper:  
Subscriber Phone Number:  
Subscriber Date of Birth:  
Medications and Dosage:

AMERICANS WITH DISABILITY ACT - For individuals with disabilities, please list any reasonable accommodation(s) required for you/your child's participation in camp:

THIS WAIVER SIGNED BY PARENT/LEGAL GUARDIAN/PARTICIPANT IF 18+ MUST BE BROUGHT BY CAMP PARTICIPANT TO THE CAMP TO PARTICIPATE, NO EXCEPTIONS.

Check this box if you have read and agree to the terms above.

For any questions or inquiries, please email us at info@ztmotorsfootballcamp.com.

June 17, 2017 from 9:00 AM

At Fort Walton Beach High School Stadium.