LIABILITY WAIVER AND RELEASE FORM (MINOR CHILD)

THIS IS A RELEASE OF LEGAL RIGHTS — READ AND UNDERSTAND BEFORE SIGNING.

I hereby certify that I am the adult parent or guardian of _________________, a minor child under the age of eighteen years, and I consent to his/her participation in recreational activities during the WE Run program (the “Program”) located at Cherokee Elementary, acting by and through Amex Health, LLC and his/her use of equipment supplied by Amex Health, LLC. 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 Program and (2) his/her use of the equipment. 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 Amex Health, LLC and their employees shall have no responsibility to pay for medical treatment and related costs if said minor child is injured. I further understand and agree that Amex Health, LLC supplies the equipment “as is”, and that Amex Health, LLC 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 Program and the equipment. To the fullest extent allowed by law, I hold harmless and agree to indemnify Amex Health, LLC, 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 Program and use of the equipment, 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.

HAVING READ THE ABOVE TERMS AND INTENDING TO BE LEGALLY BOUND HERBY UNDERSTANDING THIS DOCUMENT TO BE A COMPLETE WAIVER AND DISCLAMER IN FAVOR OF AMEX HEALTH, LLC, I HEREBY AFFIX MY SIGNATURE HERETO.

Parent/Guardian name (please print clearly) _________________________________________________

Parent/Guardian signature ____________________________________Date _______________________

Amex Health, LLC

By ______________________________________________________Date_______________________

Lamia Scherzinger, its Member and in her individual capacity.

 

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