by Ursyne » Tue Jun 21, 2011 10:00 pm
Realm of Khador, BMCS non-Khador Waiver & Release Form
In consideration of receiving permission from Khador Belegarth Medieval Combat Society to participate in any activity, event, tournament, or contest that the realm of Khador sponsors or supervises, the Undersigned releases Khador, Reuben Aldeen Park and any other designated practice location within the city of Rockford, Illinois, the owner of any premises where any Khador activity, event, tournament, or contest occurs, from any and all liability, claims, demands, actions, and causes of action, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the Undersigned, or any property of the Undersigned, while participating in any activity, event, tournament, or contest that Khador sponsors or supervises.
The Undersigned being duly aware of the risks and hazards inherent upon participating in any activity, event, tournament, or contest of the realm of Khador elects voluntarily to participate, knowing that participation requires physical contact by others to the person of the Undersigned and knowing that such participation may become hazardous and dangerous during the time that the Undersigned voluntarily assumes all risks of loss, damage, or injury, including death, that may be sustained by the Undersigned, or any property of the Undersigned while participating in any activity, event, tournament, or contest that the realm of Khador sponsors or supervises.
This release shall be binding upon the distributees, heirs, next of kin, executors and administrators of the Undersigned and Undersigned's minor child.
In signing the foregoing release, the Undersigned acknowledges and represents:
1. That he or she has read the above release, understands it, and signs voluntarily;
2. That he or she is over 18 years of age and of sound mind; and is the parent or legal guardian of the minor child named below;
3. Undersigned represents that he or she has no physical or mental defects known to the
Undersigned and unknown to the appropriate representative of Khador that would endanger or harm the Undersigned while participating in any activity, event, tournament, or contest that the realm of Khador participates, sponsors, attends, or supervises.
_________________________________ ________________________________
Undersigned (Sign Name Here) Undersigned (Print Name Here)
_____________________________________ _________________________
Name of Minor Child Minor’s Birthday Date/Year
_________________________________ ________________________________
Fighting Name Realm
______________________________________________ __________________________
Address (City, State, Zip) Phone Number
______________________________________________________________________________
Emergency Contact (Name, Relationship, Phone)
_____________________________________________________________________________
Any known allergies and/or medical conditions
Horde win!
Destroyer of ninja chairs