Liability Waiver & Assumption of Risk Agreement Liability Waiver & Risk Assumption Event Name * Event Date(s) * Participant Name * Guardian’s Name (if Participant is Under 18) Email Address * Phone * Mailing Address * City / State / Zip * License Plate Number How did you hear about the event? Web Social Media Word of Mouth Other Would you like to receive Topa Institute e-newsletter? Yes No I already receive it Do you have any allergies or are you taking any medications? If yes, please explain. Please check this box if you DO NOT wish to be photographed during this event. In consideration of being allowed to participate in any way in Topa’s program and its related events and activities, I, the undersigned… I agree to follow all current federal, state and local guidelines in regards to COVID-19; I understand that there is risk of injury from the activities involved in this program, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of Topa or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of Topa immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release, indemnify and hold harmless Topa, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity, including Topa, with respect to any and all injury, disability, death, or loss or damage to person or property associated with my presence and participation, whether arising from the negligence of Topa or otherwise, to the fullest extent permitted by law. By checking this box, I certify that: (1) failure to comply with these policies and protocols may cause serious harm, disability, or death to myself and fellow participants; (2) the above reflect accurate statements; (3) neither I nor my primary care physician know of any medical reasons why I should not participate in this activity; (4) I have read and fully understand the above terms; (5) I understand that I have given up substantial rights by signing, and (6) sign freely and voluntarily without any inducement; (7) if I am signing on behalf of a minor, the above terms apply to the minor and myself. If you are human, leave this field blank. Submit
