Form Center

2. Prairie Township Community Center Liability Waiver

   I (adult participant, parent, legal guardian) acknowledge that participation in Prairie Township Recreation programs may involve some risk of physical injury due to the nature of the activities. In consideration for acceptance of these programs, I do hereby release and forever discharge, for myself, my heirs, executors and administrators, any and all claims to collect damages which I/any person for whom I am responsible may incur in these activities, and any and all rights to such damages against Prairie Township or its representatives, employees, independent contractors, agents or officials, directors, sponsors, or any officials of these programs. This includes any transportation involved with travel related to these programs. I further represent that I/any person for whom I am responsible is in the physical condition to participate in these programs. I am aware that this waiver is valid for any program registrations received by Prairie Township until a revised form is required or received.

   I understand that participants may be videotaped or photographed during Recreation Department programs, activities and events. My photo, video and film likeness, and that of any person for whom I am responsible, may be used by the program, activity and event holders, producers, sponsors, organizers and/or their assigns for any legitimate purpose and I will hold the released parties harmless, on behalf of myself and any person for whom I am responsible and the parents, guardians and others as outlined above, for such use.

   If the participant is a minor or otherwise legally incapable, the undersigned parent and natural guardian or legal guardian of the participant hereby represents and certifies that he or she is, in fact, the parent or legal guardian of said child or person for whom I am responsible and that he or she possesses the authority to act in such capacity and does here by so act and agrees to indemnify and hold harmless the released parties from all liabilities and costs as outlined above as may be imposed upon the released parties because of any defect in or lack of legal capacity to execute this release and so act and to release said parties on behalf of the child or person for whom I am responsible and parents or guardians and others as outlined above.

   I have read and understand the Liability Waiver. Refusal to sign will prevent processing of the Pass. Each Adult Pass Holder (18+) must provide their own signature.

4. Participant First Name*
5. Participant Last Name*
7. Parent/Guardian First Name
8. Parent/Guardian Last Name
10. Certification of Agreement*

    Checking this box certifies that you have read and agree to the liability waiver and sends your agreement to Prairie Township.

    1. I certify and agree to the liability waiver above.
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11. 1. Receive an email copy of this form.
12. Email address

    This field is not part of the form submission.

13. Submit

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