STORM CHASER SERVICES LLC FARM SCHOOL & SUMMER DAY CAMP ACTIVITY LIABILITY RELEASE WAIVER OF RIGHT TO SUE AND ASSUMPTION OF ALL RISKS
USE OF OUTDOOR SPACES FOR ACTIVITIES
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I, (PARENT/GUARDIAN NAME TYPED BELOW BESIDE OTHER CHECKBOX), the undersigned have read and understand, and freely and voluntarily enter into this Release and Hold Harmless Agreement with Storm Chaser Services LLC, AKA Storm Chaser Stables at 705 Terre Haute Lane, Palmyra, VA 22963, including its owners, their family members, agents, sponsors, employees, independent contractors, staff, and the property owners and/or renters of Terre Haute Lane, Palmyra, VA 22963, hereinafter referred to as SCS LLC. *
Please check your response and type your name only if you are the ADULT PARTICIPANT or PARENT/GUARDIAN of PARTICIPANT. If the participant is a minor, this form must be filled out by the parent/guardian as the "responsible party."
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I understand that this Release and Hold Harmless Agreement is a waiver of any and all liability(ies). I understand and sign on behalf of myself or my minor child, hereinafter referred to as PARTICIPANT(S): (PLEASE TYPE PARTICIPANT NAME BELOW BESIDE OTHER CHECKBOX), as applicable. *
Please check your response and type the name of the PARTICIPANT(S) and type the initials of responsible party.
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I understand the potential dangers that PARTICIPANT(S) could incur in while engaging in day camp activities, including but not limited to visiting the pond/creek/river, trampoline, and outdoor spaces/equipment; I acknowledge that any water activity and trampoline use is inherently risky due to the possibility of drowning and head, neck, or spine injuries, respectively; I acknowledge that outdoor activities such as hiking, games, arts and crafts, etc run the risk of injury, including but not limited to insect bites, adverse reactions to plant matter (ie poison ivy rash), and injury and/or death related to physical activity or games (ie tripping/falling while hiking, playing tag, or other games) or outdoor equipment use (ie falling out of swing/hammock/etc). *
Please check your response and type the initials of responsible party.
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I understand and agree that all risks related to use of trampoline and outdoor spaces or equipment cannot be fully moderated or reduced despite SCS LLC supervision. Understanding those risks, I hereby release SCS LLC and anyone else directly or indirectly connected with SCS LLC from any liability whatsoever in the event of injury or damage of any nature, including death, to me, my minor child, my property, or anyone else caused by, or incidental to, my electing to engage in activities or use equipment owned or operated by SCS LLC. *
Please check your response and type the initials of the responsible party.
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I understand, recognize, and warrant that this Release and Hold Harmless Agreement is being voluntarily and intentionally signed and agreed to, and that my signature absolves SCS LLC and affiliated persons of any liability(ies) related to use of trampoline or outdoor spaces, including death, personal injury and/or damage to property. If signed electronically, I agree that my typed name is legally binding. *
Please check your response and type the initials of the responsible party.
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Today's Date *
This liability release and waiver enters full effect on the following date. Permission may be retracted in writing.
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Signature: *
Please check your response and type the full name of the responsible party.
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A copy of your responses will be emailed to the address you provided.
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