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Field Trip Medical Release Waiver

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I () hereby certify that I am the adult parent or guardian of , a minor child under the age of eighteen years in , and I consent to his/her participation in recreational activities at Polar Ice Skating located at 4227 West 5th Ave, Chicago, IL. I understand and acknowledge that I am fully aware of and assume the risks (including but not limited to the risk of serious bodily injury, property loss or damage) of (1) said minor child’s participation in recreational activities at the Rink and (2) his/her use of the Skates. I recognize my responsibility to ensure that said minor child participates only in those activities for which he/she has the required skills, qualifications, training and physical conditioning. I understand that Adventure Rafting Inc. shall have no responsibility to pay for medical treatment and related costs if said minor child is injured. I further understand and agree that Adventure Rafting Inc. supplies the Skates “as is”, and that Adventure Rafting Inc. disclaims all warranties, express or implied, including warranties of merchantability and fitness for a particular purpose. Knowing the risks described above, I agree, personally and on behalf of the minor child named above, to assume all the risks and responsibilities surrounding my minor child’s use of the Rink and the Skates. To the fullest extent allowed by law, I hold harmless and agree to indemnify Adventure Rafting Inc., its officers, directors, faculty, staff, volunteers, employees and agents, from and against any present or future claim, cause of action, loss or liability for injury to person or property, which said minor child may suffer or for which said minor child may be liable to any other person, related to said minor child’s participation in recreational activities at the Adventure Raft World, resulting from any cause whatsoever, and regardless of fault. I am at least eighteen years of age and have carefully read and freely signed this Liability Waiver and Release Form (Minor Child). I understand and agree that no oral or written representations can or will alter the contents of this document. I agree that this agreement shall be governed by the laws of the Commonwealth of the Moon (excluding its conflict of laws principles). Drop off will be at: 8am on the southside parking lot Pickup will be at: 6pm on the northside parking lot Emergency Contact Parent: Emergency Contact Parent's Phone: Secondary Emergency Contact: Secondary Emergency Contact's Phone: Allergies or special instructions:

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November 1, 2016 1:50 pm PDT

Field Trip Medical Release Waiver Uploaded by Sue Griffin - curious@wpesign.com IP 68.106.9.15