The Hub Page 22

WRD

Waiver and Release of

Liability Form

8. Double-spaceandkeythefollowinginformationcentered,single-spaced,and14pointbold:

WaiverandReleaseofLiability,AssumptionofRisk,Indemnity,andParentalConsentAgreementforThe
Hub

9. Double-spaceandkeythefollowinginformationjustified,single-spaced,and10point:

InconsiderationofbeingallowedtoparticipateinanywayinanyeventoractivityatTheHub,I,the
undersigned,acknowledgeandagreethatbyparticipatinginanyactivity,event,workshop,contest,
rehearsal,orperformance,thereisapossibilityofphysicalinjury.Ivoluntarilyagree,therefore,to
assumeallrisksandresponsibilityforanysuchinjuryoraccidentwhichmightoccurtomeormy
child(ren)duringanyofTheHub'sactivities.Ialsoexempt,release,andindemnifyTheHub,itsowners,
agents,volunteers,assistants,employees,guestperformers,and/ormembersandpatronsfromany
andallliabilityclaims,demands,orcausesofactionwhatsoeverandfromanydamage,loss,injury,or
deathtome,mychild(ren),orpropertywhichmayariseoutoforinconnectionwithparticipationin
anyactivitiesoreventsconductedatTheHub.Ifurtherherebyvoluntarilyagreetowaivemyrights
andassigntoholdTheHub,itsowners,agents,volunteers,assistants,employees,guestperformers,
membersand/orpatronsliableforsuchdamage,loss,orinjury.IunderstandthatIshouldbeaware
ofmyphysicallimitationsandagreenottoexceedthem.IfIamsigningthiswaiverformychild(ren),I
certifythatIamtheparentorlegalguardianandhavetherighttowaivetheserights.

10. Double-spaceandkeythefollowinginformationleft-aligned,italicized,andsingle-spaced:

Ihavereadthisreleaseofliabilityandassumptionofriskagreement,fullyunderstanditsterms,
understandthatIhavegivenupsubstantialrightsbysigningit,andsignitfreelyandvoluntarilywithout
anyinducement.

11. Double-spaceandkeythefollowingcustomer/memberinformationleft-alignedandsingle-spaced.Allowthe

underlinetoextendtotherightmarginwithoutwrappingtothenextline:

SignatureDate_______________________________________________________________
(Ifparticipantisundertheageof18,parent/legalguardiansignature)
Parent/LegalGuardianSignature___________________________________________________
CustomerorMember(pleasecircletoindicateone-timevisitornewmembership)
PrintedNameofCustomer/Member________________________________________________
Address,City,State,andZip______________________________________________________
__________________________________________________________________________
HomePhone_________________________________________________________________
CellPhone__________________________________________________________________
EmailAddress________________________________________________________________
EmergencyContactName_______________________________________________________
Contact'sRelation_____________________________________________________________
Contact'sPhoneNumber________________________________________________________

For Evaluation Purposes Only