YMCA of Boulder Valley Member/Children
Release & Waiver of Liability and Indemnity Agreement
In CONSIDERATION of being permitted to utilize the facilities, premises, services and programs of the YMCA (or
for my children to so participate) for any purpose, include, but not limited to observation or use of facilities,
premises or equipment, or participation in any off-site program affiliated with the YMCA, the undersigned, for
himself or herself and such participating children and any personal representatives, heirs and next of kin, hereby
acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will,
inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that
such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated
program constitutes and acknowledgement that such premises and all facilities and equipment thereon and such
affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same
as being safe and reasonably suited for the purposed of such observation, use or participation by the undersigned
and such children.
IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT
NOT LIMITED TO OBSERVATION OR USE OF PREMISES, FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY
OFF-SITE PROGRAM AFFILIATED WITH THE YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:
THE UNDERSIGNED ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES,
DISCHARGES AND CONVENANTS NOT TO SUE the YMCA and all branches thereof; its directors, officers,
employees, and agents (hereinafter referred to as “releasees”) from all liability to the undersigned or such
children and all his personal representatives, assigns, heirs and next of kin for any loss or damage, and any claims
or demands therefore on account of injury to the person or property or resulting in death or the undersigned or
such children whether caused by the negligence of the releasees or otherwise while the undersigned or such
children is in, upon, or about the premises or any facilities or equipment therein or participating in any program
affiliated with the YMCA.
THE UNDERSIGNER understands that the YMCA reserves the right to screen for and deny access OR membership
to any person who has been convicted of any crime involving unlawful sexual conduct or are a registered sex
offender.
THE UNDERSIGNED HEREBY AGREES TO IMDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of
them from any loss, liability, damage or cost that may incur due to the presence of the undersigned or such
children in, upon or about the YMCA premises or in any way observing or using any facilities, premises or
equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence
of the releasees or otherwise.
THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR
PROPERTY DAMAGE to the undersigned or such children due to the negligence of releasees or otherwise while in,
about or upon the premises of the YMCA and/or while using the premise or any facilities or equipment thereon or
participating in any program affiliated with the YMCA.
THE UNDERSIGNED further expressly agrees that the foregoing RELEASE AND WAIVER OF LIABILITY AND
INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of
Colorado and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding,
continue in full legal force and effect.
THE UNDERSIGNED HAS READ AND VOLUNTEARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND
INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from
the foregoing written agreement have been made.
______________________________________________ ______________________________ _____________
Signature (Parent/Guardian if under 18) Printed Date
______________________________________________ ______________________________ _____________
Signature of 2nd Adult Printed Date
Child’s Name ___________________________________ Child’s Name __________________________________
Child’s Name ___________________________________ Child’s Name __________________________________
