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Girls 3rd-5th Basketball Camp

Monday November 17th ,24th, Dec 1st, 8th, & 15th. 5:30-6:30

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (Read Carefully Before Signing) I, the undersigned, acknowledge that I have voluntarily consented to participate in activities on real property owned by the Village of Dieterich, Illinois.   In consideration of being permitted to participate in any activities on property owned by the Village of Dieterich, Illinois, I, the undersigned, agree:  1. I fully understand and acknowledge:  a. All activities and all other hazards and exposures connected with such activity involve risk of harm, including, but not limited to bodily injury, partial and/or total disability, paralysis, and death. b. The social and economic losses and/or damages, which could result from these risks and dangers as described above, could be severe.  c. These risk and dangers may be caused by the action, inaction, or negligence of myself or other participants in the activities, or the action, inaction, negligence from others.   d. There may be other risks not known to the undersigned or are not reasonably foreseeable at this time.  2. I agree, accept, and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis, death, or loss of personal property and expenses however caused and whether caused in whole or in part by the negligence of the Village of Dieterich, Illinois, and each and every one of its officers, employees, contractors, and agents.    3. I do hereby take action for myself and completely, absolutely, and finally RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE the Village of Dieterich, Illinois, and each and every one of its officers, employees, contractors, and agents FROM ALL LIABILITY TO THE UNDERSIGNED, my estate, distributes, devisees, heirs, next of kin, personal representatives, executors, administrators, successors and assigns, FOR ANY AND ALL LOSS, LIABILITY, DAMAGE, CLAIM, CAUSE OF ACTION, INJIURY, DEMAND, SUIT, COSTS, EXPENSE OR ATTORNEY FEE THEREFORE ON ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE UNDERSIGNED OR DAMAGE TO PROPERTY WHICH MAY BE CAUSED, OR MAY AT ANY TIME ARISE AS A RESULT OF, IN WHOLE OR IN PART, BY ANY AND ALL Volleyball CLASS ACTIVITIES OR ANY OTHER SIMILAR ACTIVITIES ARISING OUT OF OR ASSOCIATED WITH MY PARTICIPATION IN SAID ACTIVITIES ON ANY REAL PROPERTY OWNED BY THE VILLAGE OF DIETERICH, ILLINOIS.  It is my intention to completely, absolutely and finally release the Village of Dieterich, Illinois, and each and every one of its officers, employees, contractors, and agents from any and all liability arising out of, in whole or in part, said cause and/or activities. 4. I HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage.  THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE VILLAGE OF DIETERICH, ILLINOIS, OR ANY OF ITS OFFICERS, EMPLOYEES, CONTRACTORS, AND AGENTS.  5. I further expressly agree that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect. 6. I understand and agree that, if at any time, I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further. 7. I hereby grant permission to the Wright Family Center and its representatives to take and use photographs and/or video of my child, taken during youth basketball activities, for promotional purposes. These materials may be used in publications, presentations, social media, or on the organization's website. 8. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, PHORO RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

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Payment - The link below will take you to a site called GiveButter that will allow you to pay online. Fees do apply. Click "Donate and Tickets"


Do not forget to come back after paying and hit submit!

Wright Family Center

PO Box 243

Dieterich, IL 62424

217-925-5554

Lobby and Gymnasium hours:

Sunday 12pm-5pm

Monday - Friday 8am -8pm

Saturday 9am-6pm

Make Payments to:

Village of Dieterich - Wright Family Center

P.O. Box 243

Dieterich, IL 62424

 

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