City of Plantation Parks & Recreation Department
9121 NW 2 Street, Plantation, FL 33324
LIABILITY WAIVER
Class Name: FLYBALL Date: _________________________________
____________________________________ ___________________/__________________
Dog owner’s name (Home Phone No.) (Work Pone No.)
____________________________________ _______________________________________
Home Address (City, State, Zip)
____________________________________ ______________________________________
Guardian if applicable. (Name of dog(s) in program)
City of Plantation Parks and Recreation Class Waiver
Please read this form carefully and be aware in registering yourself, you child or war for participation in this program you will be waiving and releasing all claims for injuries you or your child/ward might sustain arising out of these programs.
As a parent/guardian of a participant in the program, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries (including death) damages or loss which I or my minor child/ward may sustain with or associated with such programs.
I do hereby fully release and discharge the City of Plantation and its officers, agents, servants, and employees from any and all claims resulting from injuries (including death) damages and losses sustained by me or my minor child/ward arising out of connected with, or in any way associated with the activities of these programs.
In the event of any emergency, I authorize the City of Plantation officials to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my minor child’s/ward’s immediate care and agree that I will be responsible for payment of any and all medical services rendered including transportation charges.
I have read and fully understand the above program details, waiver and release of all claims and permission to secure treatment.
_______________________________ __________________________________________
(Name of Child/Ward if applicable) (Signature of Participant or Parent/Guardian)
_____________________________ (Date)