For More Information:
252-539-1045
Mr. Charles Edwards, Mentor
Ms. Robin McDuffie, Mentor
Warning, Liability, Release and Acknowledgment and Assumption of Risk
I understand that participation in this program may involves the risk of injury. I further understand that before participating in this program, I should consult a physician for advice. By signing this form I acknowledge all risks of injury and death and affirm that I am willing to assume responsibility should injury or death result from them. I also agree to follow all rules and procedures of the program and to follow the reasonable instruction of the facility employees and supervisors of the program. Furthermore, in return for the opportunity to participate in this program I agree for myself, and for my heirs, assigns, executors and administrators, to waive all legal rights I may have to seek payment of any kind from the Town, its employees or its agents for bodily injury or death resulting from this program and to release those parties from any liability for damages resulting from my injuries or death. This waiver and release applies to injuries from all causes and includes all payments or legal remedies I might be entitled to except if my injury or death were to be caused by the negligence of Rich Square W.S. Creecy Training and Community Center, its employees or its agents. I UNDERSTAND THAT NO INSURANCE COVERAGE IS PROVIDED BY THE COUNTY OR CDC AND I HAVE READ AND UNDERSTAND ALL THE PROVISIONS IN THE PROGRAM BROCHURES INCLUDING THE DISCIPLINE AND REFUND POLICIES.