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2. First Name*
3. Last Name*
5. Address*
7. City*
8. State
9. Zip Code
11. Email Address*
12. Phone Number
16. RECREATION WAIVER AND RELEASE STATEMENT *
    -- Select One --I agree

    In consideration of being allowed to participate in the above-mentioned Adult Athletic League, I hereby, for myself, my child, our heirs, executors and assigns, acknowledge, appreciate and agree:

    1. Participation includes the risk of serious injury or death including, but not limited to, possible exposure to and illness from infectious diseases including but not limited to methicillin-resistant Staphylococcus aureus (MRSA), influenza, and coronavirus disease 2019 (COVID-19). While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

    2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and

    3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases, including but not limited to any applicable Governor’s Executive Orders and Department of Natural Resources (DNR) and Minnesota Department of Health (MDH) guidelines related to the activity, including the Outdoor Recreational Guidelines, which can be found at https://www.dnr.state.mn.us/aboutdnr/covid-19-outdoor-recreation-guidelines.html. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and

    4. I, for myself and my child, and on behalf of our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS City of Lakeville, its officers, officials, agents, employees, and/or volunteers, other participants, sponsoring agencies, advertisers, and if applicable owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY ILLNESS, DISABILITY, DEATH, or loss or damage to person or property arising out of, or incident to my participation , WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I further agree that except in the event of the City of  Lakeville’s gross negligence and willful and wanton misconduct, I will not bring any claims, demands, legal actions or causes of action against the City of Lakeville, its officers, officials, agents, employees and/or volunteers for any injuries, death or damages to myself or my child.
18. Signature*

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    1. Signature
20. Date
    Date
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