Waterloo Region Dodgeball | Registration | Tri City Dodgeball

ADULT WAIVER

I confirm, acknowledge and agree with:

1. Being involved in this program can be significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness does exist;

2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation;

3. I willingly agree to comply with the stated and customary rules, terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will bring such to the attention of the nearest official immediately;

4. For myself and on behalf of my spouse, heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Tri-City Dodgeball their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES") with respect to any and all injury, illness, disability, death, loss or damage to person or property, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law.

I have read and understand this release of liability and assumption of risk agreement, its terms and clicking the Register button below is replacing my signature which I confirm I am doing so freely and voluntarily without any inducement.

First Name

Last Name

Phone Number

Date Agree (mm/dd/yyyy)

Thank you for completing the 2023 Waiver.

Please close this screen.

WATERLOO

| KITCHENER

| CAMBRIDGE

ADULT WAIVER

I confirm, acknowledge and agree with: