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(386) 986-2360

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(386) 986-2520
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(386) 986-3780
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(386) 986-3766
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(386) 986-3764
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(386) 986-3708
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(386) 986-3723
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(386) 986-3718
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(386) 986-2300
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(386) 986-3730
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(386) 986-2323

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(386) 313-4111
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(386) 437-4116

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This page was printed from : https://www.palmcoastgov.com/my-palm-coast/mayors-challenge/terms
Mayor's Healthy Community Challenge

Mayor's Healthy Community Challenge

WAIVER, RELEASE AND INDEMNIFICATION

I request permission to participate in the program(s) identified by me above with the understanding that there is inherent risk in the program(s) and that my participation in the program(s) could result in serious injury or death to me. I fully accept and assume all risks and responsibilities for all losses and damages incurred as a result of my participation in the program(s).

In consideration of the willingness of the City of Palm Coast to permit my participation in the program(s) and to allow me access to the City's premises and property, I hereby waive for myself and on behalf of my family members and assigns, and any persons claiming by, through or under me, any and all claims or causes of action which I may have against the City of Palm Coast, its elected officials, agents, servants, and employees ("released parties"), for all injuries and damages suffered arising from my participation in the program(s) or from my presence on or use of the premises or property of the City of Palm Coast.

In consideration of the willingness of the City of Palm Coast to permit my participation in the program(s) and to allow me access to the City's premises and property, I grant the released parties the right to photograph and/or videotape me and to use my face, likeness, voice and appearance in connection with exhibitions, publicity, advertising, promotional and commercial materials without reservation or limitation.

In consideration of the willingness of the City of Palm Coast to permit my participation in the program(s) and to allow me access to the City's premises and property, I shall defend and indemnify the released parties and hold them harmless from any all losses, suits, claims, demands, actions, costs or expenses of any nature or kind (including, without limitation, attorney's fees and costs) arising from any injury and/or damage inflicted or caused by me to another person or entity.

I have the Rules of Conduct published by the City of Palm Coast, and agree to abide by them. I recognize that if I fail to abide by the Rules of Conduct that my participation in the program(s) may be terminated, without any refund of any fees paid by me to the City of Palm Coast.


MINOR WAIVER, RELEASE AND INDEMNIFICATION

As Parent or Legal Guardian of the above-named minor Child, I hereby give my consent for Child to participate in the above- described Program, which is a community-sponsored activity. In consideration of the City's acceptance of Child into the Program and/or Child's participation in the Program, and with the understanding that Child's participation in the Program could result in serious injury, death, and/or property loss or damage, including, but not limited to, injuries caused by terrain, facilities or equipment; Child's participation in sports, games or play; use of paint or other chemicals or materials; weather; temperature; vehicular or pedestrian traffic; Child's physical abilities; actions or inactions of other people, including, but not limited to, other Children in the Program, City employees and/or contractors, or volunteers in the Program; I hereby recognizeand agree to assume all risks, known or unknown, that might arise through Child's participation in Program, and on my own behalf, on behalf of Child, and all of Child's parents, guardians, next of kin, heirs, executors and representatives, successors and assigns, and/or survivors, I release and forever hold harmless, the Released Parties as defined below, from any and all liabilities, claims, demands, damages, actions, costs or expenses of any nature, known or unknown, arising out of or in any way connected with Child's participation in the Program. I further agree to indemnify and hold each of the Released Parties harmless against any and all liabilities, claims, demands, damages, actions, costs or expenses of any nature, including, but not limited to, all attorney's fees, costs and expenses, whether at the trial or appellate level, arising out of or in any way connected with Child's participation in theProgram.

The Released Parties are the City of Palm Coast, its elected officials, officers, employees, agents, contractors, volunteers, successors and assigns. I understand and agree that this Consent, Release & Waiver of Liability includes any claimsbased on the negligence, actions or inaction of any of the Released Parties, and covers bodily injury, death and/or property damage or loss, whether suffered by me or by Child, before, during or after participation in the Program, including travel to or from the Program, whether by private transportation or City-provided transportation, or on account of any first aid, treatment or service.

I certify that my Child is physically fit, sufficiently trained and capable of participating in the Program, and has not been advised otherwise by a qualified medical person. I authorize medical treatment and services for myself and/or my Child, if the need arises, and I assume the responsibility and will fully indemnify the Released Parties for all medical and other costs incurred for such treatment andservices.

I acknowledge that the City of Palm Coast will not provide insurance coverage to me or to my Child for any bodily injury, death and/or property damage or loss, as a result of or arising out of child's participation in the program.

I have received a copy of the Parent Guide. It will be my responsibility to read the guide, to follow the regulations and procedures of the Program, and discuss the rules with my child. I understand that failure to comply with the rules of the Program could result in my Child's termination from theProgram.