COUNTY
OF DEKALB
RELEASE FORM AND STATEMENT
The undersigned, under legal name or any alias, hereby releases 1763 (herein referred to as the Club), it’s owners, managers, employees, agents, and servants, from any and all liability arising from our participation in activities and/or events held on Club premises.
It being expressly acknowledged, anticipated and understood by the undersigned that such activities and/or events involve the undersigned’s participation with other individuals in activities which involve physical contact of a sporting nature, and which activities inherently involve the risk of personal injury. Accordingly, the undersigned, as a voluntary participant in such events, assumes the risk of Personal injury by his/her participation in Club activities and/or events, and further understands that he/she and he/she alone is solely responsible for any and all consequences that may arise with regard to his/her voluntary participation in such activities.
The undersigned agrees to adhere to the posted Rules and Regulations of the Club at all times while on the premises and understands that his/her Club privileges may be withdrawn at any time if said Rules and Regulations are not followed. The undersigned further warrants that he/she is over 21 (twenty one) years of age and has read and understands this release prior to signing same.
This release applies to the undersigned at all times he/she is on Club premises from this day forward.
Signed________________________________________________________________________________________