Responsibility Waiver Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

RESPONSIBILITY WAIVER FORM

Date: {{date}}

Participant Information

Full Name: {{participant_full_name}}

ID/Passport Number: {{participant_id_number}}

Address: {{participant_address}}

Phone Number: {{participant_phone_number}}

Email Address: {{participant_email_address}}

Date of Birth: {{participant_date_of_birth}}

Activity/Event Details

Name of Activity/Event: {{activity_event_name}}

Date(s) of Activity/Event: {{activity_event_dates}}

Location of Activity/Event: {{activity_event_location}}

Description of Activity/Event: {{activity_event_description}}

Acknowledgement of Risks

I, {{participant_full_name}}, hereby acknowledge that I have voluntarily chosen to participate in the aforementioned activity/event. I understand that there are inherent risks associated with this activity/event, including but not limited to: {{list_of_risks}}.

I acknowledge that these risks could result in personal injury, illness, death, and/or property damage. I am fully aware of the nature of the activity/event and the potential hazards involved.

Waiver and Release of Liability

In consideration of being permitted to participate in the activity/event, I hereby agree to release, waive, discharge, and covenant not to sue {{company_name}}, its officers, directors, employees, agents, and volunteers (hereinafter collectively referred to as “the Released Parties”), from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or any property belonging to me, whether caused by the negligence of the Released Parties or otherwise, while participating in the activity/event, or while in, on or upon the premises where the activity/event is being conducted.

I specifically understand that this release extends to any and all claims I may have arising from the ordinary negligence of the Released Parties, and I voluntarily and knowingly assume the risk of these dangers.

Indemnification

I further agree to indemnify and hold harmless the Released Parties from any loss, liability, damage, or costs, including attorney’s fees, that they may incur due to my participation in the activity/event, whether caused by my negligence or otherwise.

Medical Treatment Consent (Optional)

In the event of a medical emergency, I consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during the activity/event. I understand that I am responsible for any medical expenses incurred.

Governing Law

This Waiver and Release of Liability shall be construed in accordance with and governed by the laws of {{country_region}}.

Severability

If any provision of this document is found to be unenforceable, the remaining provisions shall remain in full force and effect.

Signature Block

Participant’s Full Name (Printed): _________________________________

Participant’s Signature: _________________________________

Date: _________________________________

If Participant is under 18 years of age (Minor):

Parent/Legal Guardian’s Full Name (Printed): _________________________________

Parent/Legal Guardian’s Signature: _________________________________

Date: _________________________________