GENERAL RELEASE AND DISCHARGE, ACCEPTANCE OF RESPONSIBILITY, AND ACKNOWLEDGMENT OF RISKS
(This document affects your legal rights. You must read and understand it before signing it.)
Waiver for (circle one): Annual Membership Guest Spectator
Name: _______________________________________________ Date: ________________________
Address:___________________________________________________________________________
I, ______ , of lawful age and with legal capacity, hereby acknowledge, agree, promise, and covenant with Peggy Stalnaker, doing business as DuckCreek Silver Labradors & Gun Club, LLC in Cowley County, Kansas, and their respective affiliates, agents, heirs, officers, members, commissioners, managers, legal representatives, successors and assigns (herein collectively “Releasees”), to release and discharge Releasees and each of them on behalf of myself, my heirs, assigns, personal representatives and estate as follows:
1. Acknowledgment of Risk. I understand and acknowledge that the activities (the “Activities”) at the facilities and lands I am about to voluntarily engage in as a participant and/or volunteer and/or spectator bears certain known, inherent risks and other unanticipated risks which could result in injury, death, illness or disease, physical or mental, or damage to myself, to my property, or to third parties. I understand and acknowledge those risks may result in personal claims against Releasees or any of them or claims against me or other third parties.
I understand and acknowledge that a complete or exhaustive list of risks, known or unknown, identified or unidentified, anticipated or unanticipated, is impossible to define which may result in injury, death, illness, disease, or damage to myself, to my property, or to other third parties. I expressly accept those foreseeable and unforeseeable risks.
2. Acceptance of Risk and Responsibility. Being aware that each of the Activities entail risks of injury to myself and a risk of injury to other third parties as a result of my actions, I agree, covenant, and promise to accept and assume all responsibility and risk for injury, death, illness, or disease or damage to other third parties and their property arising from my participation in any of the Activities. My participation in any of the Activities is purely voluntary and no one is forcing me to participate, and I elect to participate in spite of the risks.
3. Release. I hereby voluntarily release and forever discharge Releasees and each of them, from any and all liabilities, claims, demands, actions, and/or causes of action, which are related to or arise out of, or are in any way connected with my participation in any of the Activities, including specifically, but not limited to, the negligent acts or omissions of Releasees or any of them and all other persons or entities, for any and all injury, death, illness, or disease and damage to myself or to my property. I further agree, promise, and covenant to hold harmless and indemnify Releasees and each of them and all other persons or entities from all defense costs, including attorney’s fees, and/or from any other costs incurred in connection with claims for bodily injury or property damage which I may negligently or intentionally cause to myself or other third parties in the course of my participation in any of the Activities.
4. Acknowledgment of Effect of This Release Agreement. I understand and acknowledge that by signing this document I have given up certain legal rights and/or possible claims which I might otherwise assert or maintain against Releasees or any of them and other persons or entities, including specifically, but not limited to, rights arising from or claims for the acts, omissions or negligence in any degree of Releasees or any of them, and all other persons or entities. I understand and acknowledge that by signing this document I have assumed responsibility and legal liability for claims and other legal demands, including defense costs, which may be asserted by other parties against me as a result of my participation in any of the Activities or in using the skills I have learned while participating in such events. I understand and acknowledge that no insurance is provided to me during any of the Activities. I certify that I have sufficient health, accident, and liability insurance to cover bodily injury or property damage that I may incur while participating in any of the Activities and to cover bodily injury or property damage caused to any third party as a result of my participation in any of the Activities. If I have no such insurance, I certify that I am capable of personally paying for any and all such expenses, costs and/or damages.
5. Entire Agreement. I understand that this is the entire agreement between myself and Releasees and that it cannot be modified or changed in any way by the representations or statements of others and is binding upon me and my heirs, personal representatives, estate and assigns.
My signature below indicates I have read this entire document, understand it completely and agree to be bound by its terms and conditions.
Signature: ____________________________________________________
Date: ___________________________
Highlight this document, right click, print. Complete and return to DuckCreek Silver Labradors & Gun Club, LLC:
www.DuckCreekSilvers.com 11524 101st Road Winfield, KS 67156 620.221.7284
