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In consideration of receiving permission from Beornve Medieval Re-creation Society to participate as a member of Beornve and to participate in any activity, event, tournament, contest or meeting that Beornve participates, sponsors, attends, or supervises, the Undersigned releases Beornve, the City of Davenport, the City of Rock Island, the city of Bettendorf, the city of Moline, the Bettendorf Community Center, the Celtic Highland Games of the Quad Cities, the Rock Island County Forest Preserve District, the owner of any premises where any Beornve activity, event, tournament, contest, or meeting occurs, and any other member of Beornve, individually, 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 and any minor children listed on this waiver, or any property of the Undersigned, while participating in any activity, event, tournament, contest or meeting that Belegarth Beornve participates, sponsors, attends or supervises.
The Undersigned being duly aware of the risks and hazards inherent upon participating in any activity, event, tournament, contest or meeting of the Beornve, 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 minor children listed on this waiver, or any property of the Undersigned while participating in any activity, event, tournament, contest, or meeting that the Beornve participates, sponsors, attends or supervises.
This release shall be binding upon the distributees, heirs, next of kin, executors and administrators of the Undersigned.
In signing the foregoing release, the Undersigned acknowledges and represents:
(a) That he or she has read the above release, understands it, and signs voluntarily
(b) That he or she is over 18 years of age and of sound mind
(c) Undersigned represents that he or she has no physical or mental defects known to the Undersigned and unknown to the appropriate representative of the Beornve that would endanger or harm the Undersigned or other participants while participating in any activity, event, tournament, contest or meeting that the Beornve participates, sponsors, attends, or supervises
(d) That he or she is parent or legal guardian of any minor children listed below
Printed Name Date of Birth
Street Address
City State Zip
Belegarth name (optional)
Emergency Contact Name
Medical Information (optional, used in medical emergencies and informing paramedics/doctors if necessary)
Emergency Contact Phone Number
Add to contact list? Yes No
E-mail Address
- - Add to contact list? Yes No
Phone Number
Signature (Parent/Guardian if under 18) Date
Relationship to Child
________________________________
Beornve Official Witness Date
_________________
Arvonaco Shaman
Horde win!
Member of House Paradigm
Destroyer of ninja chairs
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