(NAME OF ORGANIZATION)

EVENT PARTICIPANT/S WAIVER AND RELEASE OF LIABILITY

I, Name of Participant, of legal age, hereby knowingly and voluntarily execute this Event
Participant/s Waiver and Release of Liability (EPWRL) in relation to the upcoming Name
of Event, the terms and conditions of which are as follows:

A. I, hereby certify that, I am physically fit for participation in the event, the details of which, in
particular, are as follows:

Description of the
Event:
Period of the Event:

Venue of the Event:

I, likewise certify that, I have not been advised otherwise by a qualified medical person
and that there are no health-related reasons or problems which preclude our participation
in the event.

B. I acknowledge the risks involved and hazards connected with travelling to the place of the
event and the engagements of various activities listed in the Name of Event. I, further
acknowledge that the aforementioned activities involve a test of a person’s physical and
mental limits and it carries with it the possibility of serious injury, death, or property loss.

C. I am fully aware that my attendance and participation in the event is not required by the
event organizer and I am participating on my personal accord.

THEREFORE, AND IN CONSIDERATION OF BEING PERMITTED TO PARTICIPATE IN

THE ABOVE-MENTIONED EVENT, I hereby knowingly, willingly and voluntarily assume all of
the risks of participating in above-mentioned event which may include, but not limited to
serious injury, death, and/or property loss and we likewise hereby take action for myself, my
executors, administrators, heirs, next of kin, successors, and/or assigns as follows:

1. To waive, release, and forever discharge the following entities: Name of Organization
(hereafter collectively as the, “Event Organizers”), their partners and/or affiliates,
including their directors, officers, volunteers, representatives from any and all liability in
connection with my disability, personal injury, death, property damage, property theft or
actions of any kind, including but not limited to those caused by my negligence, which may
hereafter accrue to us, during, and/or our traveling to and from the above-mentioned
event;

2. To indemnify and hold free and harmless the event organizers and their partners and/or
affiliates, including their directors, officers, volunteers, as the event facilitators from all
claims, judgments and costs, including attorney’s fees incurred in connections with any
action brought as a result of our attendance and participation in the event;

3. Not to institute any kind of action whatsoever against all entities and/or persons
aforementioned from any and all liabilities or claims in connection with the above-
mentioned event;
 (NAME OF ORGANIZATION)

4. To indemnify, hold harmless all entities and/or persons aforementioned from any and all
liabilities or claims made by other individuals and/or entities as a result of our or the
participant’s actions during the above-mentioned event;

5. I, knowingly, willingly and voluntarily assume full responsibility for any risks of loss,
property damage or personal injury, including death, that may be sustained by us, or any
loss or damage of property owned by us, unless there is a showing of gross negligence
committed by the event organizers; and

6. I, likewise hereby give my consent to receive medical treatment that may be deemed
advisable and/or necessary in case of injury, accident, and/or illness during the event.

This Event Participant Waiver and Release of Liability (EPWRL) shall be construed broadly to
provide a release and waiver to the maximum extent permissible under the applicable law.

Finally, the invalidity of any portion of this EPWRL will not and shall not be deemed to affect
the validity of any other provision. In the event that any provision of this EPWRL is held to be
invalid, I agree that the remaining provisions shall be deemed to be in full force and effect as if
they had been executed by me subsequent to the expungement of the invalid provision.

I HAVE CAREFULLY READ THE ENTIRETY OF THIS EVENT PARTICIPANT WAIVER

AND RELEASE OF LIABILITY (EPWRL) AND FULLY UNDERSTAND ITS CONTENTS.

Participant’s
Participant’s Complete Name: Signature

Home Address:

Mobile Number:

Emergency Contact’s Name:

Emergency Contact’s Mobile
Number:
Relationship with Participant:
Participant’s
Participant’s Complete Name: Signature

Home Address:

Mobile Number:

Emergency Contact’s Name:

Emergency Contact’s Mobile
Number:
Relationship with Participant:
Participant’s Complete Name: Participant’s
Signature
 (NAME OF ORGANIZATION)

Home Address:

Mobile Number:

Emergency Contact’s Name:

Emergency Contact’s Mobile
Number:
Relationship with Participant:
Participant’s
Participant’s Complete Name: Signature

Home Address:

Mobile Number:

Emergency Contact’s Name:

Emergency Contact’s Mobile
Number:
Relationship with Participant:
 (NAME OF ORGANIZATION)

Participant’s
Participant’s Complete Name: Signature

Home Address:

Mobile Number:

Emergency Contact’s Name:

Emergency Contact’s Mobile
Number:
Relationship with Participant:
Participant’s
Participant’s Complete Name: Signature

Home Address:

Mobile Number:

Emergency Contact’s Name:

Emergency Contact’s Mobile
Number:
Relationship with Participant:
Participant’s
Participant’s Complete Name: Signature

Home Address:

Mobile Number:

Emergency Contact’s Name:

Emergency Contact’s Mobile
Number:
Relationship with Participant:
Participant’s
Participant’s Complete Name: Signature

Home Address:

Mobile Number:

Emergency Contact’s Name:

Emergency Contact’s Mobile
Number:
Relationship with Participant:
We, warrant that we have secured and/or obtained the consent of the above-named
emergency contact, to share their identity, contact information and relationship for purposes of
 (NAME OF ORGANIZATION)

providing the Event organizers a contact person in case an emergency arises which requires
their assistance.

IN WITNESS WHEREOF, we have hereunto affixed my hand on this Date day of Month,
Year at City of Venue.
Additional Consent Required:
I further understand while participating in the above-mentioned event, I may be
photographed and/or video recorded. By signing below, I hereby agree and fully give my
consent to allow my personal information in particular, my name, contact information,
emergency contact information and relevant particulars, as well as my photo, video, or film
likeness to be collected and only used for sales, promotion, and/or marketing purpose by the
above-mentioned event organizers and their assigns.
NO NAME SIGNATURE
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