Apr 05

Indemnification Waiver

To download free Liability waiver form in PDF, please click Indemnification Liability Waiver



WAIVER OF LIABILITY, INDEMNIFICATION, AND MEDICAL RELEASE
To be signed by adults participating in the event.
Acknowledgment and Assumption of Risk
I am aware of the dangers and the risks to my person and property involved in participating in:
_____________________________________________________________________________________
____________________________________________________________________________________.
I understand that this activity involves certain risks for physical injury. I also understand that there are
potential risks of which I may not presently be aware. Because of the dangers of participating in this
activity, I recognize the importance and agree to fully comply with the applicable laws, policies, rules and
regulations, and any supervisor’s instructions regarding participation in this activity.
I understand that the State of North Dakota (State) does not insure participants in the above-described
activity, that any coverage would be through personal insurance, and the State has no responsibility or
liability for injury resulting from this activity.
I voluntarily elect to participate in this activity with knowledge of the danger involved, and I hereby
agree to accept and assume any and all risks of property damage, personal injury, or death.
Waiver of Liability and Indemnification:
In consideration for being allowed to voluntarily participate in the above-referenced event, on behalf of
myself, my personal representatives, heirs, next of kin, successors and assigns, I forever:
a. waive, release, and discharge the State of North Dakota and its agencies, officers, and employees
from any and all negligence and liability for my death, disability, personal injury, property damages,
property theft or claims of any nature which may hereafter accrue to me, and my estate as a direct or
indirect result of my participation in the above referenced activity or event; and
b. defend, indemnify, and hold harmless the State of North Dakota, its agencies, officers and
employees, from and against any and all claims of any nature including all costs, expenses and
attorneys’ fees, which in any manner result from participant’s actions during this activity or event.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury,
accident or illness during this activity or event. This release, indemnification, and waiver shall be
construed broadly to provide a release, indemnification, and waiver to the maximum extent
permissible under applicable law.
I, the undersigned participant, affirm that I am at least 18 years of age and am freely signing this
agreement. I have read this form and fully understand that by signing this form I am giving up
legal rights and/or remedies which may otherwise be available to me regarding any losses I may
sustain as a result of my participation. I agree that if any portion is held invalid, the remainder will
continue in full legal force and effect.
READ BEFORE SIGNING
Name: ______________________________________
Signature: ____________________________________ Date: _________________
Witness: ____________________________________ Date: _________________

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