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City of Santa Ana
<br />RELEASE OF LIABILITY &
<br />ASSUMPTION OF RISK WAIVER
<br />Human Resources Department
<br />20 Civic Center Plaza M-24
<br />P.O. Box 1988
<br />Santa Ana, CA 92702
<br />Phone:714-647-5340 Fax:714-647-6930
<br />Activity or Event:
<br />Activity/Event Date(s) and Tinne(s):
<br />Activity/Event Location(s):
<br />This agreement contains a release of liability and an assumption of risk and it waives important legal rights,
<br />please read it carefully)
<br />In consideration for being allowed to participate in the above Activity/Event, on behalf of myself and my next of kin, heirs
<br />and representatives, I release from any and all liability and promise not to sue, the City of Santa Ana, its elected
<br />officials, its public officials, employees, volunteers, consultants and agents (collectively "City"). This release includes claims
<br />of the City's negligence, resulting in any physical or psychological injury, pain, suffering, illness, damages, economic or
<br />non -economic loss that I may suffer because of my participation in this Activity/Event, including travel to and from this
<br />Activity/Event.
<br />I acknowledge that I am voluntarily participating in this Activity. I am aware of the risks associated with participating in this
<br />Activity/Event and traveling to and from this Activity/Event. The risks may include the personal injury, death, disfigurement,
<br />pain, suffering, loss of earnings, psychological injury, and other potential economic and non -economic damages. I
<br />understand that these injuries could occur as the result of my own or someone else's actions, failure to act, or negligence;
<br />conditions of travel, geographic conditions, or Activity/Event specific risks and conditions. Nevertheless, I assume all
<br />related risks of my participation in this Event/Activity, both known and unknown, including traveling to and from
<br />this Activity/Event.
<br />I agree to hold harmless the City from all claims, including attorney's fees and costs; damage to my own personal property;
<br />and any other injuries or damages that may occur as a result of my participation in this Activity/Event. If the City incurs any
<br />of these types of expenses, I agree to reimburse the City. If I need medical treatment, I agree to be financially responsible
<br />for any costs incurred as a result of this treatment. I am aware and understand that I should carry my own health insurance.
<br />I am 18 years or older. I understand the consequences of signing this Release of Liability and Assumption of Risk
<br />document, including a release of City from any and all claims for personal injury and damages; assuming all of the
<br />risks associated with participating in this Activity/Event including travel to and from the Activity/Event; and
<br />promising not to sue the City.
<br />I understand that there is the possibility that I may be interviewed, photographed and/or videotaped during this particular
<br />activity, and I hereby allow the City staff to use the photographs, interviews, and/or video materials for City publicity
<br />purposes.
<br />I have read this agreement and understand its contents. I understand that by signing this document, I am releasing the City
<br />of Santa Ana, its elected officials, public officials, employees, consultants, volunteers, and agents from any and all liability of
<br />any kind associated with my participation in this Activity/Event.
<br />PARTICIPANT SIGNATURE:
<br />DATE: 11
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