Waiver

TOWN OF ARLINGTON
Release Form

Please print and fill out completely


Name of Participant:______________________________________________________

Name of Parent or Legal Guardian:_________________________________________

Street Address ___________________________________________________________

City:___________________________________________

State:__________________________________________

Zip:____________________________________________

Home Phone:_____________________________________

Cell Phone:_____________________________________

E-Mail address ___________________________________________________________

RELEASE AND WAIVER OF LIABILITY AGREEMENT
I am aware of the activities that I am voluntarily participating in and I agree to assume any and all risks of bodily injury, property damage, whether those risks are known or unknown. I hereby release, forever discharge and agree to hold harmless the Town of Arlington, its directors, employees and agents from all claims or liabilities of any kind relating to the participation of any programs on Town of Arlington property and/or right-of-ways.

Please sign below:

Signature: _________________________________________________

Date:_____________________________________________________

Parent or Legal Guardian:_____________________________________

Date:_______________________________________________________

 
Event: Arlington Arsenal, I further certify that my child is currently covered by Health Insurance.