LAST NAME:___________________________________ DATE:_________________________
WAIVER AND RELEASE OF LIABILITY
AND ASSUMPTION OF RISK ACKNOWLEDGEMENT
DEFINITIONS:
Facilities – The Blue Mailbox Farm including Cane Creek,
Indemnitees – BMF, LLC and Blue Mailbox Farm, 6400 Hwy 100 West, Pleasantville, TN 37033
Indemnitor(s) – The individual(s) signing below, and his/her heirs, administrators, executors, and assigns.
The Indemnitor(s) hereby releases the Indemnitees from any liability for damages from illness, injury and/or death that arises out of, or is connected with, or in any manner relates to, Indemnitor’s use of the Facilities and services provided at the Facilities.
Indemnitor(s) represents that:
1. I am 18 years of age or older and understand and agree that I assume total responsibility for any minor children who accompany me to use the Facilities.
2. I am submitting this release, waiver of liability, and assumption of risk declaration voluntarily and of my own free will.
3. I have no physical or emotional problems, nor any history thereof, which will impair my ability to utilize the Facilities and its services in a safe manner.
4. I understand and agree that it is my responsibility to assess the hazards presented by my use of the Facilities and services of the Facilities, and further agree that I am the ultimate judge as to whether I can use the Facilities and services without risk of harm to myself.
5. I understand and EXPRESSLY ASSUME all the dangers incident to using the Facilities and their services, and hereby RELEASE ALL CLAIMS, including but not limited to, personal injury, property damage or destruction, and death, whether caused by NEGLIGENCE, breach of contract or otherwise, and whether for bodily injury, property damage or loss otherwise, which I may ever have against the Indemnitees.
6. My use of the Facilities is entirely optional and my own free choice. My use of the Facilities is in no way a requirement of BMF, LLC and The Blue Mailbox Farm.
Signature(s):________________________________________________________________________________________
Print Name(s):______________________________________________________________________________________
Address:___________________________________________
___________________________________________________
Phone:_____________________________________________