Participant Waiver Release Form

RELEASE AND WAIVER OF LIABILITY AGREEMENT I, (“Participant”), acknowledge that I have voluntarily applied to participate in the following jump-a-thon at: (Please write in your location and your name)

I will be jumping rope and fully understand that I am doing this at my own risk. I acknowledge I am free from any disease or health challenge that would impair me or cause me harm while jumping rope at this jump-a-thon event. I will not hold the location or sponsored organizations or Jumps 4 Joy responsible for any injury caused by my own jumping or attendance at this event. I am fully aware that participating in this event may cause injury to myself. I am voluntarily participating in this activity with full knowledge of the possible danger involved, and agree to assume any and all risks of bodily injury, death or property damage, whether those risks are known or unknown. (Description of activities, which Participant will engage in) I also agree that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee {Jumps 4 Joy or any such person associated with organization, Sponsored Organization, and Location} in connection with any of the matters covered by the foregoing release. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND JUMPS 4 JOY, THE SPONSORED ORGANIZATIONS, THE EVENT LOCATION, THE COUNTY, AND THE LESSOR, AND SIGN IT OF MY OWN FREE WILL.

If Signed by Parent or Guardian: I verify that the dangers of the activities and the significance of this Release and Waiver were explained to the Participant and that the Participant understood them. Executed at (location),

Your State

on ,

20 Event Date

PARTICIPANT/RELEASOR _____________________________

PARENT OR GUARDIAN ________________________________

Signature

Signature

Address:_______________________

Address:_________________________

IF YOU ARE UNDER 18 YEARS OF AGE, YOU AND YOUR PARENT OR GUARDIAN MUST SIGN AND INITIAL THIS FORM WHERE INDICATED. THANK YOU FOR JUMPING TO LEAVE A FOOTPRINT ON A CHILDS HEART!