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YOUR SIGNATURE INDICATES THAT YOU HAVE READ AND UNDERSTANDING THE FOLLOWING.
RENTAL TIME = SAMBA SOCCER FACILITY (whole
building – Field & seating area).
Rental fee includes setup & cleanup in your allocated
rental time slot.
If you go over your allocated time you will be charged
accordingly.
All rentals require a
nonrefundable deposit of $40.00 one-week before the desired date.
NAME ORGANISATION /PERSON
RESPONSIBLE FOR RENTAL _______________________________
PHONE (
) _____________________
DATE OF RENTAL ___________TIME
OF RENTAL FROM ___am/pm to _____am/pm
HOURLY RATE: $80.per hour
DEPOSIT $ ______
Received ________Cash
Credit Card Check
# _________
BALANCE DUE $ _______Received __________
Cash
Credit Card Check
# ______
Be advised there maybe other Rentals @ Samba before or after
your rental, so please be courteous. Samba staff is only
required to be @ Samba during allocated rental times & are NOT
responsible or required to referee games.
RELEASE AND WAIVER OF LIABILTY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT (“AGREEMENT”)
In consideration of being permitted
to participate in SOCCER-DODGEBALL-FLAG FOOTBALL
activity (“Activity”) I, for myself, my personal
representatives, assigns, heirs and next of kin:
1.
ACKNOWLEDGE, agree and represent that I understand the nature of SOCCER-DODGEBALL-FLAG
FOOTBALL 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 conditions
to be unsafe; I will immediately discontinue further participation in
the Activity.
2.
FULLY UNDERSTAND that: a) SOCCER-DODGEBALL-FLAG FOOTBALL
ACTIVITIES INVOLVE RISK AND DANGERS OF SERIOUS BODILY INJURY,
INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH
(“RISK”): b) these risks and dangers may be caused by my
own actions or inaction’s, the actions or inaction’s of
others participating in the Activity, the condition in which the
Activity takes place, or THE NEGLIGENCE OF THE “RELEASEES”
NAMED BELOW: c) there may be OTHER RISKS 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
RESPONSIBILTY FOR LOSSES, COSTS AND DAMAGES I incur as a result of my
participation or that of the minor in the Activity.
3.
HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE SAMBA SOCCER,
their respective administrators, directors, agents, officers,
members, volunteers, and employees, other participants, and any
sponsors, advertisers, and if applicable, owners and lessers of
premises on which the Activity takes places, (each considered one of
the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS,
DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLGED TO BE IN
WHOLE OR IN PART BY THE NEGLIENCE OF THE “RELEASEES” OR
OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, AND FUTHER AGREE
that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF
RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, make a claim
against any of the releasees, I WILL IDEMNIFY, SAVE AND HOLD HARMLESS
EACH OF THE RELEASEES from any litigation expenses, attorney fees,
loss, liability, damage, or cost which any 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 ANY
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 THE 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.
MINOR RELEASE
AND I, THE MINOR’S PARENT
AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF SOCCER-DODGEBALL-FLAG
FOOTBALL ACTIVITIES AND THE MINOR’S EXPERIENCE AND
CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH,
AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACITVITY.
I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO
INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ALL
LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES I ON THE MINOR’S
ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE
NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING
NEGLIGENT RESUCE OPERATIONS AND FUTHER AGREE THAT IF, DESPITE THIS
RELEASE, I THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A
CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY,
SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION
EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY MAY
INCUR AS THE RESULT OF ANY SUCH CLAIM.
SIGNATURE_______________________________________________ Date______
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