August 4-5, 2017 – IPL Record Breakers Waiver Form

August 4,5 – IPL Record Breakers Waiver Form


 

RELEASE OF LIABILITY -- READ BEFORE SIGNING
In consideration of being allowed to participate in any way in the August 4th & 5th, 2017 IPL Record Breakers, USPA , its related events and activities,
I, , the undersigned, acknowledge, appreciate, and agree
that:
1. The risk of injury from the activities involved in this program is significant, including the
potential for permanent paralysis and death, and while particular skills, equipment, and personal
discipline may reduce this risk, the risk of serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF
ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for
my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation.
If, however, I observe any unusual significant hazard during my presence or participation, I will
remove myself from participation and bring such to the attention of the USPA officials
immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin,
HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE Meet Director/promoter, USPA, Dixie Center, Chris McGrail, Utah Powerlifting LLC, and their officers,
officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers,
and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH
RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property,
WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest
extent permitted by law.

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent
and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs,
assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any
and all liabilities incident to my minor child's involvement or participation in these programs as
provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent
permitted by law.  Emergency Phone #: Date Signed: 

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 FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Age:  Date Signed: 

 

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Signature Certificate
Document name: August 4,5 – IPL Record Breakers Waiver Form
Unique Document ID: a37ad0cdbae59afde695e37cb53be0ef930a2ed1
Timestamp Audit
2016-12-19 09:57:37 MDTAugust 4,5 – IPL Record Breakers Waiver Form Uploaded by Utah Powerlifting LLC - info@utahpowerlifting.com IP 65.158.216.146