Activities Release and Waiver of Liability
Activities Release and Waiver of Liability
Notice: This form contains a release and waiver of liability and when signed is a contract between the
undersigned participant and XXX LLC with legal consequences. Please read this Agreement, consisting of one
(1) pages in its entirety, carefully before signing your name at the bottom of the page. This form must be signed
in the presence of one (1) witness who should sign as witness.
Date of Execution of Release and Waiver of Liability:
The undersigned agrees that this “Activities Release and Waiver of Liability” form agreement is valid from the
date of execution through the date of discharge.
Acknowledgments and Representations by Client:
The undersigned is currently a client of XXX LLC. The undersigned has voluntarily consented to participate in
voluntary sports activities or voluntary physical activities such as volleyball, aerobics, and other such type of
voluntary sports or physical activities, which may not be specifically identified herein, while being a client at such
facility. The undersigned acknowledges and represents that their participation in such sports activities and
physical activities is not a mandatory requirement of XXX LLC, and that any participation by the undersigned in
any and all sports related activities and physical activities, is purely voluntary and of the undersigned’s own free
will. The undersigned acknowledges and represents that there has been no coercion or force on the part of XXX
LLC for the undersigned to execute this release and waiver of liability agreement. The undersigned has
knowingly, freely and voluntarily consented to execute this release and waiver of liability agreement. The
undersigned acknowledges and understands that it is the undersigned’s sole decision to participate in such
voluntary activities. The undersigned acknowledges and represents that he has been informed that he has an
absolute right to refuse to participate in any and all sports related activities or physical activities.
To XXX LLC, Inc.: In consideration of the opportunity afforded to me, by XXX LLC, to participate in voluntary
sports activities or voluntary physical activities such as volleyball, aerobics, and any other similar types of
voluntary sports or physical activities which may not be specifically identified herein, the undersigned client freely
agrees to make the following contractual representations and agreements with XXX LLC.
The undersigned client, does hereby knowingly, freely, and voluntarily assume all liability for any damage or
injury that may occur as a result of my (or my dependent/ward) participation in the activities described herein and
agree to release, waive, discharge, and covenant not to sue XXX LLC, its officers, agents, employees, and
volunteers from any and all liability or claims that may be sustained by me or a third party directly or indirectly in
connection with, or arising out of participation in the activities described herein, whether caused in whole or in
part by the negligence of XXX LLC, or otherwise.
The undersigned client, has read this form, fully understand its terms, and understand that, I have given up
substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature
and intend it to be a complete and unconditional release of any and all liability to the greatest extent allowed by
law, and I agree that if any portion of this contract is held to be invalid the balance notwithstanding, shall continue
in full legal force and effect.
I also agree, that the rules provided to me by the XXX LLC, will be followed during the course of my voluntary
participation in the activities described herein. Otherwise, my privilege of participating in such activities will be
revoked immediately. Each client must sign a release and waiver of liability form in order to participate in the
voluntary activities described herein. I acknowledge that due to the nature of the activities described herein, XXX
LLC staff will not be able to prevent injuries from occurring during the course of such activities; therefore, I am
choosing to participate in such activities at my own risk and agree to assume all risks associated therewith.
Indemnification of XXX LLC: The undersigned client shall at all times hereafter indemnify, hold harmless and,
at XXX LLC Attorney’s option, defend or pay for an attorney selected by XXX LLC to defend XXX LLC, its
officers, agents, servants, and employees against any and all claims, losses, liabilities, and expenditures of any
kind, including attorney fees, court costs, and expenses, caused by negligent act or omission of the client, other
clients, XXX LLC, its employees, agents, servants, or officers, or accruing, resulting from, or related to the
undersigned client engaging in any voluntary sports activities or voluntary physical activities such as volleyball,
aerobics, and any other similar types of voluntary sports or physical activities which may not be specifically
identified herein, including, without limitation, any and all claims, demands, or causes of action of any nature
whatsoever resulting from injuries or damages sustained by any person or property. The provisions of this
section shall survive the expiration or earlier termination of this Agreement or the discharge of the client from the
residential/outpatient facility operated by XXX LLC.
Venue: This Agreement shall be interpreted and construed in accordance with and governed by the laws of the
State of . Venue for litigation concerning this Agreement shall be in County.