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I, the participant/parent or guardian of the participant, recognize and acknowledge that activities with the Town of Castle Rock may have an element of hazard or inherent danger, including risk of serious injury, which might result from participant action, inaction, negligence of others, rules of play, or the condition of the premises or any equipment used thereon. Further, I understand that there may be other risks not known or reasonably foreseeable at this time and that such risks shall be assumed by the undersigned.*

Accept

I agree to indemnify and hold harmless the Town of Castle Rock, its employees, agents, and volunteers from any loss, damage, or injury which may result from my or my child’s participation in activities sponsored by the Town of Castle Rock. This release of liability and indemnity applies equally to losses, damages, or injuries caused or alleged to be caused in whole or in part by the negligence of the Town. I further agree to release, waive, and discharge, and covenant not to sue the Town for any claims, demands, or actions whatsoever arising out of any damage, loss, or injury incurred on or to me or my child as a result of my participation or my child’s. This release of liability and indemnity applies to me, the undersigned, or my child, as well as any personal representatives, assigns, heirs, and next of kin.*

Accept

In my absence, I authorize the employees of the Town of Castle Rock to call for emergency services should they be necessary in the case of injury during the times that the above named individual is participating in an activity sponsored by the Town of Castle Rock. I authorize the attending physician at the hospital to administer necessary emergency medical care to the above named individual upon arrival at the hospital. I will accept responsibility for the payment of any and all treatment provided therein including emergency rescue services.*

Accept

I certify that the above named is capable of participating safely in Town of Castle Rock programs. I understand that the Town does not provide accident, health, or life insurance coverage for the above named participant.*

Accept

I further understand that I am legally responsible for actions of the above named individual including, but not limited to, any damage to private or public property.*

Accept

I hereby grant the Town of Castle Rock and the Parks and Recreation Department the right and license to use my or my child’s image for internal and external audiences. This includes, but is not limited to, the purpose of promoting the REAL Adaptive Recreation Program.*

Accept

The information obtained in this document is confidential.

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