Name
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First Name
Last Name
Email
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Cell
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Best Times for Class
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check all that work for you in general
Best Days for Class
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check all that work for you in general
Locations
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which areas work best for you
Please read and check the box to agree to the following prior to arrival, thank you.
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I acknowledge that this Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.
I hereby assume any and all risks of participation in any and all activities associated with this event, including by way of example and not limitation, any risks that may arise from negligence or unintentional carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am physically fit, have sufficiently prepared, trained or will be trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.
In consideration of permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: In consideration of permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, or participating in this activity.
(B) THE FOLLOWING ENTITIES OR PERSONS: Tancie Trail, dba PURE, dba estPURE.co, San Bernardino County, Los Angeles County and any other participants and volunteers.
INDEMNIFY, HOLD HARMLESS, promise not to sue nor pursue other legal action against the entities or persons mentioned in this waiver from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity, and am fully privately responsible for costs associated with medical treatment I receive.
