MID PENINSULA WATER POLO CLUB

WAIVER AND RELEASE OF LIABILITY AND MEDICAL RELEASE FORM

 

I acknowledge I have voluntarily chosen to participate in the above referenced activity and I have full knowledge of the risks this activity presents.

I understand by being permitted to participate in this activity, I agree to assume any and all risk of injury or death. I further understand and agree to assume responsibility for risk of theft, loss, or damage to my personal property, which may occur at any time arising out of my participation in this activity.

I understand and agree as a condition of participation in this activity, I will release from liability and will indemnify the Mid-Peninsula Water Polo Club, their officers, directors, agents, employees, assigns, successors, or lessors for any damage, injury, or death to myself or any other persons or property, in any way connected with my participation in this activity. I understand there exist specific hazards associated with this activity, to include injury and/or death, and I accept full responsibility for these hazards.

I have carefully read this agreement and fully understand all of its terms and conditions. I understand this is a release of liability, which could legally prevent me from filing a lawsuit or making any other legal claim for damages in the event of my death or injury. With this knowledge, I am entering into this agreement fully and voluntarily. I agree the agreement is binding upon me, my spouse, my heirs, my children including any guardian ad litem for the children, my assignees, and legal representatives.

I understand and agree by signing this waiver and release on behalf of my minor child that I am giving up the same rights for the minor as I would be giving up if I signed this document on my own behalf.

MEDICAL TREATMENT CONSENT: I, the person and/or legal guardian of the listed named, authorize Mid-Peninsula Water Polo Club to seek medical treatment for the listed named, as they may deem necessary at any medical facility.

I understand and agree that I have read this entire waiver, release, and consent, have been provided with all necessary information, and I agree with the terms and conditions. MPWPC does not provide insurance coverage for club participants for injuries occurring while participating in play or practice of club/intramural activities.  Any injury claim must be filed with the student’s own group insurance.  Prior to participation, participants must review their own private coverage and understand the coverage and limitations of their personal policy in regards to extracurricular activities.  We, the undersigned, have reviewed our personal insurance policies and understand that the MPWPC is not responsible for any injury sustained by participants associated with the sports program.