Minor Waiver Form


Minor Participant Name:  

Date: 

WAIVER OF LIABILITY, RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT

Her Game International, Inc. (“HGI”) operates a sports performance, facility rentals, indoor sports

leagues, personal training, and athletics facility located at 5119 West Chester Pike, Newtown Square, PA

(“HGI Location”). HGI and its members, owners, employees, officers, agents, representatives, any owner

of the HGI Location, and the heirs, successors and assigns of all of the foregoing are collectively referred

to as the “HGI Parties”. The HGI Location and all facilities, equipment and other fixtures or personal

property as may be there from time to time are collectively referred to as the “HGI’s Facilities”.

I, , residing at ,

am the parent or legal guardian of , born on

  , and residing at , and I am executing this Waiver

of Liability, Release, Assumption of Risk and Indemnification Agreement (“Agreement”) on this date,

, in order to induce HGI to permit Participant’s use of HGI for HGI’s permission for

Participant to use HGI’s Facilities and equipment and to participate in HGI’s programs and activities at

the HGI Location (“HGI Activities”), and, intending to legally bind myself, Participant, and any other

parent or legal guardian of Participant and our heirs, executors, personal representatives, assigns and

estates, I hereby acknowledge, warrant and agree to the following:

1. Authority and Permission. As the parent or legal guidance of Participant, I have the authority to

execute this Agreement on his/her behalf, and on behalf of any other parent or legal guardian of

Participant, and I hereby grant my permission for Participant to use HGI’s Facilities and to participate

in HGI Activities.

2. Release, Covenant Not to Sue, and Agreement to Indemnify.

A. On behalf of myself, Participant, and any other parent or legal guardian of Participant, I hereby

knowingly and voluntarily, FOREVER RELEASE, DISCHARGE AND AGREE TO HOLD HARMLESS all HGI

Parties from any and all claims, demands, or causes of action of any kind which are in any way

associates with, related to, and/or arising from Participant’s presence at and/or use of HGI’s

Facilities and/or participation in HGI Activities, including but not limited to, those for losses, injuries

or damages pertaining to any property loss, personal injury, or death suffered or sustained by

Participant, whether or not such losses, injuries or damages are caused solely, or in part by the

negligence (including ordinary negligence and gross negligence), recklessness, carelessness or other

fault of any of the HGI Parties (“Claims(s)”) now and in the future. We agree to indemnify all HGI

Parties for any and all costs, charges or expenses, including reasonable attorneys’ fees incurred in

connection with any said Claim now and in the future.

B. On behalf of myself, Participant and on behalf of any other parent or legal guardian of

Participant, I hereby understand, agree and acknowledge that by signing this Agreement, WE EACH

VOLUNTARILY WAIVE AND RELEASE ANY RIGHT TO SUE OR OTHERWISE BRING ANY CLAIM (as defined above), AND WILL BE PRECLUDED FROM, SUING OR OTHERWISE BRINGING ANY CLAIM (as

defined above) against any of the HGI Parties including, but no limited to, any Claim for losses,

injuries or damages pertaining to any property loss, personal injury, or death suffered or sustained

by Participant, whether or not such losses, injuries or damages are caused solely or, in part, by the

negligence (including ordinary negligence and gross negligence), recklessness, carelessness or other

fault of any of the HGI Parties. This also means that a Claim cannot be pursued by or on behalf of

the Participant against any of the HGI Parties for contribution or indemnity (or to share the liability)

if a claim, demand, or cause of action of any kind is asserted against Participant which is in any way

associates with, related to, and/or arising from Participant’s presence at and/or use of HGI Facilities

and/or participation in HGI Activities.

C. On behalf of myself, Participant and on behalf of any other parent or legal guardian of

Participant, I hereby understand, agree and acknowledge that if suit or other claim of any kind is

brought on behalf of Participant against a part other than HGI Parties for any property loss, personal

injury, or death suffered or sustained by Participant which is any way associates with, related to,

and/or arising from Participant’s presence at and/or use of HGI’s Facilities and/or participation in

HGI Activities and any HGI Parties become a party to such claim or suit, then, IN ORDER TO RELIEVE

ANY GHI PARTIES FROM LIABILITY TO MAKE CONTRIBUTION TO ANOTHER PARTY, ANY MONEY

JUDGEMENT OBTAINED AGAINST ANY SUCH OTHER PARTY SHALL BE RELEASED AND REDUCED TO

THE EXTENT OF THE HGI PARTIES’ PRO RATA SHARE OF DAMAGES RECOVERABLE AGAINST ALL

OTHERS.

D. Furthermore, on behalf of myself, Participant and any other parent or legal guardian of

Participant, I hereby covenant, warrant and agree that should any of us, or the heirs,

representatives, assigns or estates o any of us, breach this Agreement by commencing a lawsuit, or

by otherwise bringing a Claim against any of the HGI Parties which is in any way associates with,

related to, and/or arising from Participant’s presence at and/or use of HGI’s Facilities and/or

participation in HGI Activities, pursuant to this Agreement, WE SHALL INDEMNIFY AND BE

INDIVIDUALLY AND JOINTLY LIABLE TO HGI Parties for any and all costs, damages, losses, and

expenses, including judgments, fines, settlements, punitive damages and attorneys’ fees, arising

from any such threatened, pending or instituted Claim, where civil, criminal, administrative or

arbitrative, and any appeal to such a Claim.

3. Governing Law. On behalf of myself, Participant and on behalf of any other parent or legal guardian

of Participant, I hereby understand, agree and acknowledge that this Agreement shall be construed

under the internal laws of the Commonwealth of Pennsylvania without reference to conflict of laws

principles, as broadly and inclusively as is permitted thereby; and that if any portion of provision of

this Agreement shall be held invalid, illegal or unenforceable, this shall not affect the validity or

enforceability of any other provision of this Agreement. This Agreement may not be amended or

modified except by an agreement in writing signed by the party against whom the enforcement of

any modification is sought.

 

4. Acknowledgements. On behalf of myself, Participant and any other parent or legal guardian of

Participant, I hereby understand, agree and acknowledge: (A) THAT I HAVE HAD SUFFICIENT

OPPORUTNITY TO READ THIS ENTIRE DOCUMENT; (B) THAT I HAVE READ AND UNDERSTAND THIS

DOCUMENT, AND AGREE TO BE BOUND BY ITS TERMS; (C) THAT I HAVE NOT RELIED ON ANY ORAL

OR WRITTEN REPRESENTATIONS MADE BY HGI OR ANY OF ITS MEMBERS, OWNERS, EMPLOYEES,

OFFICERS, AGENTS OR REPRESENTATIVES; (D) THAT I AM FULLY AWARE THAT THERE ARE RISKS

CONNECTED WITH PARTICIPANT’S USE OF HGI’s FACILITIES AND PARTICIPATION IN HGI ACTIVITIES

AND; (E) THAT I AM SIGNING THIS DOCUMENT VOLUNTARILY, AND OF MY OWN FREE WILL.

5. Continuing Nature. On behalf of myself, Participant and any other parent or legal guardian of

Participant, I understand, agree and acknowledge that the releases, covenants, promises, warranties

and obligation.

IF ONLY ONE PARENT OR GUARDIAN EXECUTES THIS AGREEMENT ON BEHALF OF PARTICIPANT

WHO IS UNDER 18 YEARS OF AGE, THEN THE UNDERSIGNED PARENT OR GUARDIAN OF THE

PARTICIPANT HEREBY COVENANTS, WARRANTS, REPRESENTS AND AGREES THAT HE OR SHE IS

EXECUTING THIS AGREEMENT ON BEHALF OF, AND AN AGENT FOR, ANY OTHER INDIVIDUAL

WHO MAY BE A PARENT OR GUARDIAN OF THE PARTICIPANT, AND THAT BY EXECUTING THIS

AGREEMENT, THE UNDERSIGNED IS BINDING HIMSELF/HERSELF, THE PARTICIPANT, AND ANY

OTHER PARENT OR GUARDIAN OF THE PARTICIPANT, AND ALL OF THEIR HEIRS, EXECUTORS,

PERSONAL REPRESENTATIVES, ASSIGNS AND ESTATES.

READ BEFORE SIGNING

I have reviewed the CDC website at cdc.gov/headsup regarding concussions.

 

 

Guardian’s Telephone Number:   

Her Game International https://www.hergame.com
Signature Certificate
Document name: Minor Waiver Form
Unique Document ID: 9a8083f18a7f36b053b6e48f2f42bc3c3b3152bc
Timestamp Audit
2015-11-19 21:56:01 EDTAdult Uploaded by Keith Amen - rufonetllc@gmail.com IP 76.99.39.99