RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
IN CONSIDERATION of being permitted to participate in the NCMIC/Professional Solutions Summer Breeze Run scheduled for July 28, 2018 (hereinafter the "Activity"), each of the undersigned for himself/herself, his/her personal representatives, heirs, and next of kin:
1. Acknowledges, agrees and represents that he/she has or will immediately upon arriving at the location of the Activity, and will continuously thereafter, inspect the location and all equipment he/she is permitted to use, and further agrees and warrants that, if at any time, he/she feels anything to be unsafe, he/she shall immediately advise a representative of NCMIC Group/Professional Solutions of such and if necessary will leave and/or refuse to participate further in the Activity.
2. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE NCMIC Group, Inc., and all of its subsidiaries and affiliates, and each of their directors, officers, employees, agents, representatives, insurers, and reinsurers, or other owners or lessees of the premises and equipment used in the Activity and others who give recommendations, directions or instructions or engage in risk evaluation, loss control or insurance activities regarding the premises, equipment or any actions involved in the Activity, collectively referred to as "Releasees," FROM ALL LIABILITY TO THE UNDERSIGNED, his/her personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO AND/OR PARTICIPATION IN THE ACTIVITY, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
3. HEREBY AGREES TO IDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them FROM ANY LOSS, LIABILITY, DAMAGE, OR COST they may incur arising out of or related to the Activity, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
4. HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or related to and/or participation in the Activity, WHETHER CAUSED BY THE NEGLIGENCE OR RELEASEES OR OTHERWISE.
5. HEREBY acknowledges participation in the Activity may be dangerous and involve the risk of serious injury and/or death and/or property damage. He/she is voluntarily participating in the Activity with the full knowledge of the dangers involved, and hereby agrees to accept ANY AND ALL RISKS of property damage, personal injury, and/or death arising out of or related to and/or participation in the Activity, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. He/she also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES and hereby agrees to accept ANY AND ALL RISKS of property damage, personal injury, and/or death arising out of or related to such rescue operations or procedures of the releases.
6. HEREBY agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to ALL NEGLIGENT ACTS by the Releasees, and is intended to be as broad and inclusive as is permitted by the laws of the State of Iowa, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
7. HEREBY agrees to indemnify and save and hold harmless the Releasees and each of them from any loss, liability, damage, or cost they may incur arising out of related to any loss of consortium claim brought by his/her spouse and/or children brought as a result of or related to the Activity, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. The undersigned specifically recognizes and agrees that loss and cost described in this paragraph includes reasonable attorney's fees, expert expenses and litigation costs incurred in the defense of any loss of consortium claim identified above.
8. I grant NCMIC/Professional Solutions, its representatives and employees the right to take photographs of me and my property in connection with above identified subject. I authorize NCMIC/Professional Solutions, its assignees and transferees to copyright, use an publish the same in print and/or electronically. I agree that NCMIC/Professional Solutions may use such photographs of me with or without my name and for an lawful purposes, including for example such purposes as publicity, illustration, advertising and Web content.
I CERTIFY THAT I HAVE READ THIS RELEASE AND WAIVER OF LIABILTIY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT.
I CERTIFY THAT I FULLY UNDERSTAND ITS TERMS AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT.
I AM OF LEGAL AGE AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT MY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME.
I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
Please Sign Below
Your electronic signature is the online equivalent of your ink-on-paper signature, and can be provided by typing your name where indicated. The electronic signature will signify your understanding, acceptance, and authorization to accept the conditions of this legal document, including the following statements:
I have read, have understood, and do accept the agreement above.
I understand that this is a legal document with effects that I approve and authorize.
I am authorized to agree to the terms of this document on behalf of the registrant.
I assert that I am the parent/legal guardian or otherwise authorized to execute a legally binding agreement on behalf of the registrant.
An authorized adult must complete this form.