To the best of my knowledge, Participant is in good health and adequately immunized to participate in this program. In the event
Participant is injured or should require medical attention, I authorize the securing of necessary medical treatment. I acknowledge that I will
be responsible for all costs associated with any medical treatment. Confirmation of this authorization will be attempted if the
circumstances permit prior treatment by calling the telephone numbers provided.
To the fullest extent permitted by law, Participant and Participant’s parent or guardian agree to indemnify, defend, save, and hold harmless
Lake Havasu City, its departments, agencies, boards, commissions, officers, officials, agents, volunteers, and employees (“Indemnitee”) for,
from, and against any and all claims, actions, liabilities, damages, costs, losses, or expenses (including, but not limited to, court costs,
attorneys’ fees, and costs of claim processing, investigation and litigation) to which any Indemnitee may become subject, under any theory
of liability (“Claims”) to the extent that Claims are caused by the negligent acts, recklessness, or intentional misconduct of the Participant
arising out of or as a result of participation in this program. Participant/Parent/Guardian agrees to be responsible for primary loss
investigation, defense, and judgement costs where this indemnification is applicable.
Participant and Participant’s parent or guardian waive the right to any claim for damages or injury of any kind on behalf of Participant,
accruing to Participant arising out of or as a result of participation in the program.
I declare that I am the Participant’s parent or guardian. I acknowledge that I read this form completely and understand the responsibilities
and privileges of participating in this program. Participation in this program is voluntary. Lake Havasu City is not responsible for lost or
stolen items. Lake Havasu City reserves the right to reconcile customer balances when participant has available account credit.
