LIABILITY WAIVER - Town of Altona
Organizing Committee: YFC Altona - Youth Unlimited
THIS FORM MUST BE READ AND SIGNED BY ALL WHO WISH TO PARTICIPATE.
Elements of risk:
Recreational activity programs involve certain elements of risk and injuries may occur while participating in such activities. Following are examples of some types of injury which may result from participating in the above (Activity):
1. Scrapes, cuts, bruises
2. Strains, sprains, pulled muscles or ligaments
3. Possible fractured or broken bones (such as arms, legs, hips).
There may also be risk of other types of injury.
There also exists the risk of damage to my personal property.
Release and Indemnification Agreement:
I (participant and parent/guardian) hereby release the (Municipality), the (Organizing Committee) and its agents from any and all liability for any injury sustained by me, or damage caused to my belongings, regardless of how caused, resulting from my participation in the (Activity) on (activity date). I further agree to indemnify and save harmless the (Municipality) and the (Organizing Committee) and its staff and agents from any and all suits, demands, torts, and actions of any kind which may be brought against its staff or agents for which it/ they may become liable by reason of injury, loss, damage or death resulting from, or occasioned to, or suffered by any person or any property, by reason of any act, neglect, or default of mine. This includes any actual or alleged loss, liability, damage, compensation, injury, sickness, disease, death, medical payment, defence cost, cost, expense or any other amount, directly or indirectly and regardless of any other cause contributing concurrently or in any sequence, originating from, caused by. arising out of, contributed to by, resulting from, or otherwise in connection with a Communicable Disease or the fear or threat (whether actual or perceived) of a a) the substance or agent includes, but is not limited to, a virus, bacterium, parasite or other organism or any variation thereof, whether deemed living or not, and b) the method of transmission, whether direct or indirect, includes but is not limited to, airborne transmission, bodily fluid transmission, transmission from or to any surface or object, solid, liquid or gas or between organisms, and c) the disease, substance or agent can cause or threaten bodily injury, illness, emotional distress, damage to human health, human welfare or property damage.
**Communicable Disease** means any disease which can be transmitted by means of any substance or agent from any organism to another organism where:
a) the substance or agent includes, but is not limited to, a virus, bacterium, parasite or other organism or any variation thereof, whether deemed living or not, and
b) the method of transmission, whether direct or indirect, includes but is not limited to, airborne transmission, bodily fluid transmission, transmission from or to any surface or object, solid, liquid or gas or between organisms, and
c) the disease, substance or agent can cause or threaten bodily injury, illness, emotional distress, damage to human health, human welfare or property damage.