We Bring the Game to You! Acknowledgement and Assumption of Risk
This Document Must Be Signed by the Participant in a Program Held under the Harlan2l LLC Which owns and operates this Tournament.
Harlan21 strives to provide a safe environment for its Community Sport Participants. However, it is important for the community Sports Participant to understand that even with safety measures; participation in community Sports involves unavoidable exposure to an inherent risk of injury. Therefore, the individuals names on this form below as "Harlan21 Community Sports Program, hereto (the "Program"), and further acknowledges his or her full understanding and appreciation that there are risks of injury associated with participation in the Program These risks included, but are not limited to, injuries sustained from falling, reasonable sport-appropriate contact with another Adult Sports Participant or overexertion. These risks occur in activities including, but not limited to practice, games, tournaments, competitions, and on-field celebratory behavior.
The person signing this document hereby represents that he or she has advised Harlan21 of any Facts known to him or her which would make the Adult Sports Participant more susceptible to injury or risk of injury as a result of participating in the Program that would be the average person of the same age. Further, the Participant acknowledges that he or she must be over the age of 18 or have parent consent to participate in the Program, and represents that he or she meets this minimum age requirement by signing this document.
By signing this form, community Sports Participant, on behalf of himself or herself, his or her heirs, assigns, legal and personal representative(s). agrees to assume all risks and responsibilities surrounding Community Sports Participants participation in the Program and further to release Harlan21 LLC, and it's tournament sponsor, and all departments and divisions thereof from any claims, demands, actions, causes of action, lawsuits, expenses or losses (including court costs and all reasonable attorney fees) he or she may have on account of personal injury (including death) arising out of or attributable to Adult Sports Participant's participation in the Program, whether such personal injury or death is caused by the negligence of Harlan21 LLC, its trustees, employees or agents, or otherwise.
Executed this day of November ,2007
Printed Name Of Adult Sports Participant ____________________
Signature of Adult Sports Participant _______________________
Team Name ___________________________________________
IMAGE AND LIKENESS PERMISSION: \ further consent to the use of Harlan21 community Sports Program Participant's name, image and likeness depicting his/her participation in the Event (in literary, audio, visual, photographic, film, video or other form) Harlan21 LLC for archival and in Harlan21 LLC promotional material only.
Signature _____________________________________________
Address __________________________________________
City State Zip ____________ ______________ __________
Email Phone_________________________________________