IN CONSIDERATION of being permitted to participate in any way in the ___________________ activity (“Activity”) I,
for myself for personal representatives, assigns, heirs and next of kin:
1. ACKNOWLEDGE, agree and represent that I understand the nature of ________________ activities and
that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further
agree and warrant that if at any time I believe the conditions to be unsafe, I will immediately discontinue
further participation in the Activity.
2. FULLY UNDERSTAND THAT : (a) _________________ ACTIVITIES INVOLVE RISKS AND DANGERS OF
SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH (“RISKS”);
(B) these risks and dangers may be caused by my own actions or inaction s or inactions of others
participating in the activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE
“RELEASES” NAMED BELOW; (c ) there may be OTHER RISK AND SOCIAL AND ECONOMIC LOSSES
either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL
SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of
my participation or that of the minor in the activity. I ALSO FULLY UNDERSTAND THAT NO MOLDED
CLEAT SHOES, METAL CLEAT SHOES, AND SCREW IN CLEAT SHOES ARE PERMITTED AND THAT
ONLY SNEAKERS AND TURF SHOES ARE ALLOWED.
3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE: HAMPTONS FIELDHOUSE LLC,
GERHART PONTO, as Landlord, 62 Old Country Rd LLC, and/or their associates, their respective
administrators, directors, agents, officers, members, volunteers, and employees, other participants, any
sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Activity takes place,
(each considered one of the “RELEASES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES,
OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY
THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE
OPERATIONS AND I FURTHER AGREE that if , despite this RELEASE AND WAIVER OF LIABILITY,
ASSUMPTION OF RISK , AND INDEMNITY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES
from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of
such claim.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP
SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR
ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF
ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF
THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL
FORCE AND EFFECT.
