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Insurance Waiver and Release of Liability Agreement

Media Release Agreement

Spina Bifida Association of North Texas

INSURANCE WAIVER & RELEASE OF LIABILITY FORM

In consideration of being allowed to participate in any way in Spina Bifida Association’s programs, related events and activities, I and/or the minor participant, for myself, and on behalf of my heirs, assigns, personal representatives and next of kin, I agree and acknowledge as follows:

1. I agree, and agree on behalf of my minor child if applicable, that prior to participating, I will inspect, or if a parent/legal guardian, I will instruct the minor participant to inspect the facilities and equipment to be used. If I believe, to the best of my ability, that anything is unsafe, I and/or the minor participant will immediately advise the Spina Bifida Association of North Texas of such condition(s) and refuse to participate.

2. I acknowledge, and acknowledge on behalf of my minor child if applicable, and fully understand that I and/or the minor participant will be engaging in activities that might involve risk of serious injury, including permanent disability and death. I understand that severe personal, social, and economic losses might result from my own actions or inaction, from my own negligence or the negligence of others, from the rules of play, or from the condition of the premises or any equipment used.

3. I assume, and assume on behalf of my minor child if applicable, all the foregoing risks and accept personal responsibility for the damages following any such injury, permanent disability or death.

4. On behalf of myself and my minor child if applicable, I release, waive, discharge and covenant not to sue the Spina Bifida Association of North Texas, its affiliated clubs and organizations, their representative administrators, directors, board of directors, agents, coaches and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, their heirs and if applicable, the owners and leasers of the premises used to conduct the event, all of which are hereinafter referred to as "Released Parties," from demands , losses or damages on account of injury, including death or damage to property, EVEN IF CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASED PARTIES.

I/WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I/WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING, HAVE NOT CHANGED IT ORALLY AND AGREE VOLUNTARILY.
 

FOR PARTICIPANTS OF MINORITY AGE (to be completed by parent/guardian)

This is to certify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of the Released Parties and for myself, my heirs, assigns and next of kin, I release and agree to indemnify and hold harmless the Released Parties from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM RELEASED PARTIES OWN NEGLIGENCE.

 Media Release Form/Agreement

I hereby authorize and give my full consent to the Spina Bifida Association and the Spina Bifida Association of North Texas to copyright and/or publish any and all photographs, videos or film footage in which I appear while attending a Spina Bifida Association of North Texas event. I further agree that the Spina Bifida Association of North Texas may transfer or use these photographs, videos or film footage for any exhibitions, public displays, publications, commercials, artwork, advertising and television programs without limitations or reservations.

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization, COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations,limited the congregation of groups of people. Spina Bifida Association of North Texas (hereinafter the “Organization”) cannot guarantee that you (or your child if applicable) will not become infected with COVID-19. Further, attending an in-person event could increase your risk of contracting COVID-19. 
AGREEMENT 

By agreeing to this waiver, I, the undersigned, acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I (or my child if applicable) may be exposed to or infected by COVID-19 by attending the 2021 Walk-N-Roll® for SBANT (hereinafter “Event”), and that such exposure or infection may result in illness, permanent disability, and/or death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, speakers, and other Event attendees. 
I also agree to follow all applicable governmental public health and safety recommendations, including but not limited to wearing face masks/personal protective equipment; using alcohol-based hand sanitizer; frequent hand washing using soap and water; maintaining at least 6 feet of distance from others; sanitizing surfaces and objects frequently used; and following any and all other preventive measures in place at the time of the Event and/or recommended by the Organization and the CDC. 
 

VERIFICATION REGARDING LACK OF SYMPTOMS, DIAGNOSIS, AND EXPOSURE

In light of the ongoing spread of COVID-19, you (and your child if applicable) should not participate in this event if you (or your child) within the past fourteen (14) days have experienced any symptoms associated with COVID-19, which include fever, cough, and shortness of breath among others.  You (and your child if applicable) should not participate in this event if you (or your child) have been diagnosed with COVID-19 and are not yet cleared as non-contagious by state or local public health authorities or the health care team responsible for your treatment (or your child’s treatment if applicable).  By attending this Event and by signing this document, you certify that you (and you child if applicable) do not fall into the symptom or diagnosis category.

If you have not received the CDC-recommended dose(s) of the COVID-19 vaccine, you (and your child if applicable) should not participate in this Event if:

(1) you (or your child) have traveled at any point in the past fourteen (14) days either internationally or to a community in the U.S. outside of North Texas that has experienced or is experiencing sustained community spread of COVID-19; or

(2) you believe that you (or your child) might have been exposed to a confirmed or suspected case of COVID-19 within the past fourteen (14) days.

By attending this Event and by signing this document, you certify that you (and your child if applicable) have either received the recommended vaccination dose(s) or do not fall into either of these two exposure categories.

VOLUNTARY RELEASE

I acknowledge that I derive personal satisfaction and a benefit by virtue of my participation in this Event, and I willingly engage in this Event.  I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for illness of any kind that I may experience or incur after attending this Event. On my behalf (and on my child’s behalf if applicable), I hereby release, covenant not to sue, discharge, and hold harmless the Release Parties and the Organization, its affiliates, and their respective officers, directors, employees, and agents of and from the any claims, including all liabilities, claims, actions, costs or expenses of any kind arising out of or relating thereto. I understand and agree that THIS RELEASE INCLUDES ANY CLAIMS BASED ON THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE RELEASED PARTIES AND THE ORGANIZATION, whether a COVID-19 infection occurs before, during, or after participation in the Event.