Type "N/A" if none or not applicable.
AUTHORIZED PICK UP:For the protection of your child, children, or those in your care, staff MAY ask for a picture ID upon pick up. We will not release participant to any other person NOT listed. Person picking up must be 18 or older unless person is specified by the child’s legal guardian.
ASSUMPTION OF RISK I am aware and understand that programs offered by Missoula Parks and Recreation are potentially dangerous activities with the potential for death, serious injury, and property loss. These risks include but are not limited to, hazards of injury to my person or property while engaged in programs offered by Missoula Parks and Recreation. I HEREBY ASSUME ALL RISKS OF PARTICIPATING IN MISSOULA’S PARKS AND RECREATION PROGRAMS. I certify that I am physically fit, have trained sufficiently for participation in this activity, and have not been advised otherwise by a qualified medical person. I am aware and understand the risks of personal injury, accidents, and/or illness, include, but are not limited to sprains, strains, torn muscles, and/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions and/or contusions; dehydration, and/or oxygen shortage; head, neck, and spinal injuries; shock; paralysis or death; and serious injury or impairment to other aspects of my body and general health and well being.
PERMISSION TO RECEIVE FRIST AID & SECURE MEDICAL HELP I give permission for the City of Missoula personnel assigned to my activity to seek emergency medical services for me should I become injured or ill with the understanding that I am responsible for any expenses incurred. I fully understand that the City of Missoula does NOT provide any medical insurance coverage for me while participating in City of Missoula programs. I also realize that I may be attended by City of Missoula personnel assigned to my activity until medical care is available.
PERSONAL RELEASE I, do hereby for myself, my heirs, executors, administrators, successors, and assigns, release, indemnify, acquit, and forever discharge the City of Missoula, its employees, elected officials, and insurers from any and every claim, demand, right, or cause of action, property damage, personal injury, costs, loss of service, expenses of any kind, and any compensation whatsoever, which I may ever assert by reason of my or my child's presence and/or participation in THE CITY OF MISSOULA PARKS AND RECREATION DEPARTMENT PROGRAMS, including any claims which might arise from natural, environmental, or weather conditions, and/or possible airborne pathogens and viruses, including but not limited to contraction of Covid-19, as well as from the nature or condition or manufacture of any structures or appurtenances on the premises, and further including any and all claims which might arise from any use of any equipment which might be attached to or near any structures or appurtenances on the premises, or used in conjunction with the CITY OF MISSOULA PARKS AND RECREATION DEPARTMENT PROGRAM instruction, and all claims which might arise out of the acts or omissions of other persons on the premises, whether directly connected with THE CITY OF MISSOULA PARKS DEPARTMENT PROGRAMS or not.
TRANSPORATION CITY OF MISSOULA PARKS AND RECREATION DEPARTMENT staff may drive myself or my child to and from locations included in the program associated with this waiver in City vehicles.
I hereby authorize the City of Missoula to use my likeness or picture, or that of my child, in photograph/video or social media for advertising or promotion of the Parks and Recreation Programs.
I have read the above RELEASE & ASSUMPTION OF RISK AGREEMENT and fully understand its purpose. I FURTHER UNDERSTAND BY SIGNING/TYPING MY FULL NAME IN THIS DOCUMENT I MAY BE WAIVING MY LEGAL RIGHT TO A JURY TRIAL TO HOLD THE PROVIDER LEGALLY RESPONSIBLE FOR ANY INJURIES OR DAMAGES YOU MAY SUFFER DUE TO THE PROVIDER’S ORDINARY NEGLIGENCE THAT ARE THE RESULT OF THE PROVIDER’S FAILURE TO EXERCISE REASONABLE CARE”.
I willingly sign (by typing my full name) below and represent that I am 18 years of age or older and otherwise competent to execute this document, or that my legal guardian is also signing this document.
I willingly sign (by typing my full name) above and represent that I am 18 years of age or older and otherwise competent to execute this document, or that my legal guardian is also signing this document.
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