Auburn Area Recreation and Park District
Free Agent - Athletic League/Special Event

Please Print!

Sport/Event:__________________League Desired:____________

Name:_____________________________________________

Address: ______________________________________ Zip: _____________

Home Phone:________________ Work Phone: _______________________

If address, home or work phone changes, please inform A.R.D. office so that in the event we have to contact you we are able to do so.

THIS MUST BE READ BEFORE SIGNING!
AGREEMENT, WAIVER, AND RELEASE
ATHLETIC LEAGUE/SPECIAL EVENT

In consideration for being permitted by the above district to participate in an athletic league involving the above sport, I hereby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have or which may hereafter accrue as a result of my participation in said activity. This release is intended to discharge in advance the above district (its officers_, employees, and agents) from and against any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of negligence or carelessness on the part of said district (or its officers, employees, or agents). I understand that the above sport may be of a hazardous nature and/or include physical and/or strenuous exercise or activity; that serious accidents occasionally occur during the above sport activity; and that participants in the above sport activity occasionally sustain mortal or personal injuries and/or property damages as a consequence thereof. Knowing the risks involved, nevertheless, I have voluntarily applied to participate in said activity and I hereby agree to assume any and all risks of injury or death and to release and hold harmless the above district (its officers, employees, and agents) who through negligence, carelessness, or any other acts or omissions might otherwise be liable to me. It is further understood and agreed that this waiver, release, and assumption of risks is to be binding on my heirs and assigns. I further agree to indemnify and to hold the above district (its officers, employees, and agents) free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of any injury and/or property damage that I may sustain while participation in said activity. PARTICIPANTS LIVING OUTSIDE THE AUBURN RECREATION DISTRICT MUST PAY A $5 OUT-OF- DISTRICT FEE (PARTICIPANT OWNING A BUSINESS OR PROPERTY WITHIN THE DISTRICT WILL BE CONSIDERED "IN"), UNLESS OTHERWISE NOTED.

I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER AND RELEASE ON THIS PAGE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABIUTY AND A CONTRACT BETwEEN MYSELF AND THE ABOVE DISTRICT AND I SIGN IT OF MY OWN FREE WILL.

Receipt #___________Date ______________Receipted by ________