gUEST pASS
WAIVER OF LIABILITY
Muletown Rec LLC
READ THIS DOCUMENT CAREFULLY AS IT LIMITS YOUR RIGHTS
The undersigned Applicant (which term includes the Applicant and any minors for whom the Applicant is seeking a Guest Pass hereunder) hereby makes application to Muletown Rec LLC (“MTR”) for a Guest Pass at MTR’s facility located at 1446 Oak Springs Dr, Columbia, TN 38401 subject to the terms and conditions of this Application & Agreement, Policies, and the Waiver of Liability. The Policies are available at the Front Desk or online on MTR’s website: www.muletownrec.com Hereafter, the Applicant, and family members (related by biology, marriage, or under legal guardianship), and Guests may be referred to individually or collectively as Applicant or Participants, as the context dictates.
Should the Applicant be approved, Applicant agrees, on behalf of the Applicant and all Participants, to adhere to the standards of conduct and behavior required by MTR and as articulated in MTR’s Policies as such may change from time to time. Violations of these Policies may result in revocation of the Day Pass with no refund. Should the Applicant be approved, the Applicant agrees, on behalf of the Applicant and all Participants, to the terms and conditions of this Application & Agreement, Policies (as such may change from time to time with or without notice), and Waiver of Liability.
Background Checks: As part of this Application, MTR may conduct sex offender screenings. If a sex offender match occurs, MTR reserves the right to cancel the Guest Pass, end program participation, and remove visitation access. In addition, MTR reserves the right to deny access or a Guest Pass to any person who has been accused or convicted of any crime involving sexual abuse, has ever been convicted of any offense relating to the use, sale, possession, or transportation of narcotics or habit-forming and/or dangerous drugs, or is presently or habitually under the influence of dangerous drugs or chemicals, narcotics, or intoxicating beverages.
On behalf of the Applicant and all Participants, the Applicant agrees as follows:
1. Image, Likeness, Voice. From time to time, MTR may produce promotional material, and in that process, videos (with or without voice) and photographs may be taken of the Applicant and Participants. Applicant hereby grants MTR unrestricted rights to video, photograph, and record the image, likeness, and voice of the Applicant and Participants to be used by MTR in its promotional materials.
Applicant initial signifying agreement:
2. Liability Release. On behalf of the Applicant and all Participants, Applicant hereby accepts the risks from full participation in all strenuous, athletic activities and other activities (both athletic and other activities hereafter “Activities”) provided or made available by MTR. On behalf of the Applicant and all Participants, Applicant represents and warrants that the Applicant and Participants are in good health with no condition, illness, or abnormality which might subject him or her to undue personal risk from engaging in such Activities. Applicant hereby forever agrees to release and hold harmless MTR, on whose premises the Activities are provided (“Premises”), and MTR’s owner(s), managers, officers, employees, independent contractors, subcontractors, advisors, and agents (collectively “Personnel”) from any and all liability whether caused by the negligence of MTR or its Personnel or otherwise for any claim, judgment, loss, liability, damages, injury, illness, death, costs & expenses (including, without limitation, medical expenses, attorneys’ fees and costs) arising out of or pertaining to the Activities and/or the Premises while participating in the Activities and/or traveling to and from the Premises. Further, Applicant agrees forever to indemnify MTR and its Personnel for all losses, damages, mental or physical injuries, diseases, infections, other dangers, costs, and expenses incurred or suffered by MTR and its Personnel and to hold harmless MTR, MTR’s Personnel, their successors, assigns, executors, and administrators against loss from any and all claims, demands, or any other actions whether brought by the Applicant, the Participants, or any other parties on account of injuries or damages of any nature to the Applicant or the Participants arising from or pertaining to the Activities and Premises.
Applicant initial signifying agreement:
3. Medical Release. Applicant acknowledges that attendance and participation in any Activity at MTR may subject the Applicant and Participants to the possibility of mental or physical illness or injury, diseases, infections, and other dangers to various degrees (such as minimal consequences, serious ones, catastrophic illnesses or injuries, and/or death). On behalf of the Applicant and all Participants, Applicant acknowledges and agrees to accept the risk of such illnesses or injuries. In the event of such illness or injury, Applicant hereby authorizes MTR to obtain any and all medical treatment. Therefore, Applicant hereby forever releases and holds harmless MTR and its Personnel as they act or fail to act under this authorization. Further, Applicant acknowledges and expressly agrees that Applicant will be responsible for all medical and associated costs and expenses arising from or pertaining to any incident which results in medical treatment for the Applicant and all Participants.
Applicant initial signifying agreement:
4. Pools, Splash Pad, & All Aquatics. The Applicant acknowledges and agrees that the waivers and releases herein are also intended to be applied to any matter arising from or pertaining to use of the pools, Splash Pad, and participation in all aquatic activities. The Applicant acknowledges that there are dangers and hazards unique to pools and aquatic activities including, but not limited to: diving resulting in spinal cord injuries, permanent paralysis, head/brain injuries, and drowning; failure of attendants to locate victims and/or delay in emergency response time; slips and falls on wet surfaces; and exposure to waterborne illnesses, infections, and diseases. On behalf of Applicant and all Participants, Applicant agrees to follow and adhere to all MTR’s Policies pertaining to use of the pools, Splash Pad, and participation in all aquatic activities and as all such may be modified from time to time without notice by MTR and/or Personnel (particularly lifeguards). On behalf of Applicant and all Participants, Applicant acknowledges and agrees to accept the risk of such illnesses or injuries. In the event of such illness or injury, Applicant hereby authorizes MTR to obtain any and all medical treatment. Therefore, Applicant hereby forever releases and holds harmless MTR and its Personnel as they act or fail to act under this authorization. Further, Applicant acknowledges and expressly agrees that Applicant will be responsible for all medical and associated costs and expenses arising from or pertaining to any incident which results in medical treatment for the Applicant and any Participants.
Applicant initial signifying agreement:
5. Children. If Applicant’s children or any Guests are under thirteen (13) years old, a parent is required to be onsite with their children at all times unless the children are in an approved class, day program or camp wherein parental presence is not required. Parents are responsible for picking up their children on a timely basis. Applicant expressly agrees that MTR has no responsibility or associated liability for their pickup.
Applicant initial signifying agreement:
6. Participants. The Applicant further acknowledges and agrees that should the Applicant include non-family members or anyone else for whom the Applicant is not a legal guardian, then the Applicant hereby unconditionally agrees to accept full responsibility for any and all bodily injuries up to and including death that individual suffers and any and all damages to property caused directly or indirectly by that individual. The Applicant further expressly agrees to forever fully and completely indemnify and hold harmless MTR and its Personnel for all claims, demands, losses, costs, damages, and expenses arising from or related to any bodily injury up to and including death of that individual and any damages to property caused directly or indirectly by that individual.
Applicant initial signifying agreement:
7. Broad & Inclusive. The Applicant acknowledges and agrees that the waivers and releases herein are intended to be as broad and inclusive as is permitted by law, and if any portion thereof is held invalid, the Applicant agrees that the remainder will continue in full force and effect.
Applicant initial signifying agreement:
8. Policies. Applicant acknowledges that Applicant has read the Policies and understands them. The Policies are available at the Front Desk or online on MTR’s website: www.muletownrec.com
Applicant initial signifying agreement:
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Applicant does hereby agree to the terms and conditions contained in this Guest Pass Application & Agreement, Policies, and Waiver of Liability.
ACKNOWLEDGMENT. By signing this Waiver of Liability form, the undersigned verifies the following: 1) I am over the age of eighteen (18) and possess a valid state driver’s license; 2) I can read and understand the English language; 3) I have been given sufficient time to thoroughly read this Waiver of Liability form and have read said form; 4) I am voluntarily signing this Waiver of Liability form; and 5) I further agree that no representations or statements other than those set forth herein have been made to me
THIS DOCUMENT RELEASES AND WAIVES CERTAIN RIGHTS, DO NOT SIGN IF YOU DO NOT UNDERSTAND OR DO NOT AGREE WITH ITS TERMS.
Agreed to and Accepted by:
Signature:
Date
Name:
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
PARENTAL CONSENT (if participant is under 18) FOR: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please print first and last name of minor child
I, the minor’s custodial parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the Waiver and Release of Liability above and fully understand its terms and conditions. I hereby release, discharge, covenant not to sue and agree to indemnify and save and hold harmless MTR and/or the Related Parties from all liability, claims, demands, losses, or damages on the minor’s account, including, but not limited to liability, alleged to have been caused in whole or in part by the sole or partial fault or negligence of any of the MTR and/or the Related Parties. This release not only constitutes a release of all liability with respect to any injury to the minor’s person or property as characterized above, but also constitutes a release of the MTR and/or the Related Parties liability resulting from the MTR and/or the Related Parties’ future acts and/or omissions, including but not limited to negligence, and constitutes a waiver of the minor’s and the undersigned’s legal rights. I further agree that if, despite this release, the minor, I, or anyone on the minor’s behalf makes a claim against any one or all of MTR and/or the Related Parties, I will indemnify, save and hold harmless MTR and/or the Related Parties from any litigation expenses, attorney fees, loss liability, damage, and any and all costs to such MTR and/or the Related Parties that they may incur as the result of any such claim.
Printed Name of Parent or Legal Guardian
Signature of Parent or Legal Guardian
Date
If signing liability waiver for a minor, I certify that I am the legal guardian signing on behalf of person identified on this application. I understand that falsifying records is against the law and MTR may pursue all rights and remedies available at law or equity.
THIS DOCUMENT RELEASES AND WAIVES CERTAIN RIGHTS, DO NOT SIGN IF YOU DO NOT UNDERSTAND OR DO NOT AGREE WITH ITS TERMS.
Agreed to and Accepted by:
Date
Name:
Parent or Guardian Signature:
Parent or Guardian Signature:
Parent or Guardian Signature:
Parent or Guardian Signature:
Parent or Guardian Signature:
Parent or Guardian Signature:
Parent or Guardian Signature:
Parent or Guardian Signature:
Parent or Guardian Signature:
Parent or Guardian Signature:
*Work Phone:
*Emergency Contact Name:
*Emergency Contact Phone:
*Emergency Contact Relationship: