LONG ISLAND HEAT RELEASE FORM
***BY COMPLETING THE REGISTRATION BELOW, I HEREBY AGREE TO THE FOLLOWING:
In consideration of allowing my minor child (under 18) to participate in any way in the Long Island Heat Program, its related events and activities, I, the undersigned parent/guardian, 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 releases, or others, and assume full responsibility for my child's participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for my child's participation. If, however, I observe any unusual significant hazard during my presence or my child's participation, I will remove my child from the participation and bring such to the attention of the Company 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 TO LONG ISLAND HEAT PROGRAM, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessees of premises used for the activity (Releases), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person and property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law. In addition, I agree to allow Long Island Heat Program to use any photographs or videos taken at the facility for purpose of publicity.
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.
Please check the program/s below that you are registering your child for: