Medical and Emergency Release

Medical & Emergency Release
My son/daughter has my permission to attend Friendship Circle events. I agree not to hold
Friendship Circle, their partners, principals, directors, officers, affiliates, agents, employees,
contractors, representatives, members, all individuals and entities acting in concert with
Friendship Circle and any and all volunteers in any way associated with Friendship Circle.
(hereinafter "Friendship Circle") liable for any accident, loss or theft that may occur during the
course of an event. I hereby give my permission to the physician selected by the Friendship
Circle to hospitalize, and/or secure necessary treatment or anesthesia for my child, as named
above, in the event that I cannot be reached in an emergency. I hereby give my permission that
paramedics may transport my child to the nearest hospital, if necessary. I have indicated any
pertinent medical information above. I agree to the terms and conditions of this application.
Liability Waiver
I will not hold Friendship Circle liable for any accidents, injuries, damage or fatalities which
may occur in transit to/from aforementioned events
I also waive all rights to sue Friendship Circle for any of the above mentioned incidents which
may occur in transit.
BY AGREEING TO THIS WAIVER, I/WE FREELY ACCEPT AND FULLY ASSUME RESPONSIBILITY
FOR ALL SUCH DANGERS AND RISKS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH,
PROPERTY DAMAGE OR LOSS RESULTING THEREFROM.
IN CONSIDERATION OF UTILIZING THE FRIENDSHIP CIRCLE’ FRIENDSHIP CIRCLE FACILITIES,
MONKEY BARS AND CHEESE PIT, AND FOR OTHER GOOD AND VALUABLE CONSIDERATION,
I/WE HEREBY AGREE AS FOLLOWS:
1. TO WAIVE ANY AND ALL CLAIMS for personal injury including death, illness, property
damage, and negligence that I/we may have against Friendship Circle,
2. TO RELEASE THE FRIENDSHIP CIRCLE FROM ANY AND ALL LIABILITY for any loss, damage,
injury, death, medical or other expense that I/we may suffer or that any other party may suffer
as a result of my use of Friendship Circle’ facilities, Monkey Bars and cheese pit or in my
participation in the sports of Monkey Bars and cheese pit and other Friendship Circle activities,
due to any cause whatsoever.
3. TO HOLD HARMLESS AND INDEMNIFY THE FRIENDSHIP CIRCLE from any and all loss,
damages, costs, expenses, claims, liability and obligation for any property damage or personal
injury to any third party resulting from my use of Friendship Circle’s facilities, Monkey Bars and
cheese pit or in my participation in the sports of Monkey Bars and cheese pit and other
Friendship Circle activities, including but not limited to attorney fees and costs.
4. THIS RELEASE OF LIABILITY SHALL BE EFFECTIVE AND BINDING upon my heirs, next of kin,
executors, administrators, successors, and assigns in the event of my personal injury including
death, illness, and/or property damage.
5. I/WE ADDITIONALLY AGREE not to take unreasonable risks while participating in Monkey
Bars and cheese pit, and other of Friendship Circle’ activities, including but not limited to
attempting skills or tricks that I am not qualified to perform safely or causing any other
participants/spectators unreasonable risk of harm. I/we agree to follow all rules set forth by
the Friendship Circle with respect to using the Monkey Bars and cheese pit.
I/WE HEREBY CERTIFY THAT I/we am covered by my own medical insurance, and that I/we
have read and understand this Release of Liability prior to signing it, and I/we am aware that
by signing this Release of Liability I/we am waiving certain legal rights which I/we or my heirs,
next of kin, executors, administrators, successors, and assigns may have against the Friendship
Circle.
Friendship Circle shall have the right to impose any additional conditions which, in the opinion
of the Friendship Circle, will further the intent and legal rights and waivers provided herein.
This liability waiver is made and executed in the State of Connecticut and shall be governed by,
enforced in and construed in accordance with the laws of the State of Connecticut.

I/we acknowledge that in executing this waiver, I/we are not relying on
any inducements, promises, or representations made by the Releases.