Skip to main content

Participant Agreement and Release of Liability FORM

Step 1 of 2

Participant Agreement and Release of Liability

Thank you for participating today. This participant Agreement and Release of Liability (this “Release”) will be carried out by the undersigned participant (and, if the undersigned is less than 18 years of age, the undersigned participant’s parent or guardian) as of the date indicated below. Please read each section carefully and sign and date this Release where indicated. Your signature below or electronic confirmation (if this Release is completed electronically) constitutes your irrevocable and unconditional consent to the entirety of this Release. Failure to sign and date or confirm electronically this Release will make you ineligible to participate.
I, on behalf of myself and my successors, assignees, heirs, guardians, and legal representatives, hereby freely, voluntarily, and without duress executes this Release under the following terms:
1. Voluntary Participation. I desire to engage in the activities related to being a participant (the “Activities”). I acknowledge that I have voluntarily applied to participate in Autism Awareness Walk. I understand that as a participant, I will not receive payment for my services and that I am not acting as an employee of The City of Hawthorne.
2. Assumption of Risks. I understand that the Activities include work that may be hazardous to me as a participant. I hereby expressly and specifically assume the risk of injury or harm in the Activities and release The City of Hawthorne from all liability for injury, illness, death, or property damage resulting from the Autism Awareness Walk Event.
3. Release and Wavier. In consideration of the opportunity afforded me to participate in the event, I, on behalf of myself and my successors, assignees, heirs, guardians, and legal representatives, hereby irrevocably and unconditionally;
a. Release and forever hold harmless The City of Hawthorne and its staff from any liability, claims, and demands of whatever kind or nature which arise or may later arise from my Participant Activities with The City of Hawthorne.
b. I understand that this Release discharges the City of Hawthorne from any liability or claim that I may have against The City of Hawthorne concerning any bodily injury, personal injury, illness, death, or property damage that may result from my Participant Activities with The City of Hawthorne, whether caused by the negligence of The City of Hawthorne or its officers, directors, employees, or agents or otherwise.
c. I also understand that The City of Hawthorne does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness
4. Media/Video/Photo Release. I hereby grant and convey unto The City of Hawthorne all rights, title, and interest in any photographic images and video or audio recordings made by The City of Hawthorne during my Participant Activities with The City of Hawthorne, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
5. Code of Conduct. I hereby acknowledge and agree that, in connection with my participation in the Autism Awareness Walk Event, I will:
a. Treat others with respect, courtesy, and dignity.
b. Obey all local, state, and federal laws and respect local customs, culture and practice;
c. Not possess and will refrain from the use of illicit drugs, and any other illegal substances according to local, state, and federal laws (and I understand that the possession or use of any such illicit drugs and other illegal substances is prohibited at all times during the Autism Awareness Walk Event and that the possession or use of such drugs or other substances may result in criminal prosecution);
d. Refrain from sexual harassment, consisting of, but not limited to, unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature (and I understand that any such actions will not be tolerated in any manner in connection with the Autism Awareness Walk Event and will result in my immediate removal from the Autism Awareness Walk Event and all related activities);
e. Refrain from taking any action that endangers myself or others;
f. Respect at all times the facilities, equipment, rooms, buildings, and surroundings related to the Autism Awareness Walk Event; and
g. Immediately report accidents, injuries, and illnesses to the Autism Awareness Walk Event organizers or leaders. I further acknowledge and agree that The City of Hawthorne reserves the right to notify law enforcement as it deems necessary and appropriate in connection with the Autism Awareness Walk Event.
6. Knowing and Voluntary Execution. I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A CONTRACT AND A RELEASE OF LIABILITY BETWEEN MYSELF AND THE CITY OF HAWTHORNE AND THE OTHER RELEASED PARTIES ARE DESCRIBED IN THIS RELEASE AND I SIGN IT OF MY OWN FREE WILL.
Select date MM slash DD slash YYYY
Clear Signature