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CITY OF SANTA ANA <br />RISK MANAGEMENT ad&&,[%a°dHUMANRESOURCES --- <br />Managing PJsk ftough Poddim Change <br />2021 STANBRIDGE UNIVERSITY ROOT FOR CHANGE <br />WAIVER AND LIABILITY RELEASE FORM <br />TITLE OF EVENT/ACMM-Y. <br />EVENT DATE: <br />DEscRIPnciN OF EVENT/AmvRY <br />Each participant must submit/bring a signed original document or sign in person. <br />NO EXCEPTIONS <br />In consideration of being permitted to participate in )"the Event") <br />I hereby assume all responsibility for any and all risk of property damage or bodily injury that I or <br />my employees and/or personnel connected to my operations may cause or sustain while <br />participating in the Event, including my participation in activities and the use of equipment while <br />participating or providing services at the Event. <br />Further, I, for myself and my heirs, executors, administrators and assigns, hereby release, waive <br />and discharge the City of Santa Ana and its officers, directors, employees, agents and volunteers <br />of and from any and all claims which I or my heirs, administrators and assigns ever may have <br />against any of the above for, on account of, by reason of or arising in connection with my <br />participation or presence at the Event site, and hereby waive all such claims, demands and <br />causes of action. <br />Further, I expressly agree that this release, waiver and indemnity agreement is intended to be as <br />broad and inclusive as permitted by the State of California, and that if any portion thereof is held <br />invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. <br />Further, I have carefully read the foregoing release and indemnification and understand the <br />contents thereof and sign this release as my own, free act. <br />T T <br />NAME: <br />DATE: <br />.SIGNATURE (IF UNDER 18, GUARDIANS SIGNATURE) <br />NAME/ RELATIONSHIP OF GUARDIAN <br />ADDRESS: <br />Please direct questions to Risk <br />via email at <br />or call (714) 647 <br />Risk Mgmt/Insurance Requirements/English Waiver Release CY 2021 04-07-2021 <br />