Mimi’s and Papa’s Adventure Patch
RELEASE AND INDEMNITY AGREEMENT
‘BY SIGNING THIS DOCUMENT, YOU WILL WAIVE LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.
THE UNDERSIGNED (collectively the “Participant”) in consideration of voluntary activities & participation sponsored by Mimi’s and Papa’s Adventure Patch and being aware of the inherent dangers and possibility of injury associated with the working farm and pumpkin patch, including without limitation, participation in all activities, and any other presentation, performance, rides, program, or activity (collectively the “Activities”) made available to the Participant.
A. I/WE RELEASE AND DISCHARGE Mimi’s and Papa’s Adventure Patch, and the landowner, managers, employees, attorneys, representatives, affiliates, volunteers, trustees, beneficiaries, heirs, successors and assigns, and all of them (individually and collectively “Released Parties”) from and against all claims, damages, losses, expenses, and causes of action whatsoever, known or unknown, foreseen or unforeseen, anticipated or unanticipated, or as an expected or unexpected consequence thereof (called “Claims”) which could be brought against Released Parties by me/us or on my/our behalf because of accidents, disabilities, personal injuries, property damages, theft, death, or actions of any kind which may hereafter occur to me/us or to my/our property arising out of or in any way related to my/our participation in the Activities, including darkness, inclement weather conditions, encounters with wildlife, animals, reptiles and insects, terrain, and all other risks connected therewith whether stated or unstated herein, expressly waiving any law of any state or territory of the United States limited or exempting any type of claim from being completely, totally, and fully released by this release are hereby expressly waived; and
B. I/WE HOLD HARMLESS and INDEMNIFY Released Parties from and against all Claims (including reasonable attorney fees and costs of defense) brought against Released Parties because of accidents, personal injuries, property damages, theft, death, or actions of any kind which may hereafter occur to me/us or to my/our property arising out of or in any way related to my/our participation in the Activities, including darkness, inclement weather conditions, encounters with wildlife, animals, reptiles and insects, terrain, and all other risks connected therewith whether stated or unstated herein; and
C. I/WE CERTIFY AS FOLLOWS:
1. I/we are of lawful age and legally competent to sign this release and indemnity agreement, except in the event the Participant is a minor child, I/we certify also that I/we are the lawful parent, guardian, or person responsible to supervise the minor Participant and hereby sign this agreement with the minor Participant intending it to be lawfully binding upon me/us and the minor Participant and his or her heirs, personal representatives, agents, successors and assigns;
2. I/We have carefully read this document, know the contents thereof, and sign the same of my own free will without any inducement, assurance, or guarantee being made to me/us;
3. This release and indemnity agreement shall be binding upon me/us, and my/our heirs, personal representatives, agents, successors and assigns;
4. I/We are aware the Mimi’s and Papa’s Adventure Patch, offers no insurance or medical coverage to me/us as the result of any injury that may occur during participation in the activities.
5. I/We hereby consent to receive reasonable medical first aid which may be deemed advisable in the event of injury, accident, and/or illness because of participation in the Activities; and
6. I/We certify that I/we do not have any physical condition that would interfere with or limit my/our ability to participate in the Activities.
7. I/We intend my/our signatures to be a complete and unconditional release of all liability to the greatest extent allowed by law.
8. I/We understand that it is possible that photos or videos could be taken of me and/or my family. Although Mimi’s and Papa’s Adventure Patch does not actively take photos or videos, if such were to happen,I grant permission of such photos or videos taken for any legal use and understand no royalties or compensation will occur.
CAUTION: This is a Release and Indemnity Agreement – read it before signing. Dated this ____ day of _____________________, 20_____. _______________________________________ Participant’s Printed Name ________________________________________ Participant’s Signature
_______________________________________ Parent/Guardian/Supervisor’s Printed Name (if Participant is under 18 years of age) ________________________________________ Parent/Guardian/Supervisor’s Signature IF MORE THAN ONE MINOR PARTICIPANT, ADD THE ADDENDUM SIGNATURE PAGE) MIMI’S AND PAPA’S ADVENTURE PATCH, RELEASE, AND INDEMNITY AGREEMENT ADDENDUM SIGNATURE PAGE (The Release and Indemnity Agreement is Fully Incorporated Herein by Reference)
CAUTION:This is a Release and Indemnity Agreement – read it before signing. Dated this ____ day of _____________________, 20_____. ________________________________________ Participant’s Printed Name ________________________________________ Parent/Participant’s
This release must be completed for all visitors to Mimi’s and Papa’s Adventure Patch. Parents or guardians must complete it for minor children. One form can be used for a whole family.