Kingdom of Avalon
MINORS CONSENT TO PARTICIPATE AND HOLD HARMLESS AGREEMENT
(Print Minor's Legal Name)_ _________________________________ (hereafter referred to as "the minor") does hereby state that the minor wishes to participate in activities sponsored by the organization known as Kingdom of Avalon, an Ohio not-for-profit corporation (hereafter "KOA").
The KOA has rules which govern and may restrict the activities in which I can participate. These rules include, but are not limited to: Trustee Constitution, Kingdom Constitutions, Kingdom Addendum, and Executive Counsel Rulings for combat and non-combat related activities.
The KOA makes no representations or claims as to the condition or safety of the land, structures or surroundings, whether or not owned, leased, operated or maintained by the KOA.
The minor's parent(s) or guardian(s) understand that all activities are VOLUNTARY and that the minor does not have to participate. It is understood that these activities are potentially dangerous or harmful to the minor's person or property, and that by participating, the minor's parent(s) or guardian(s) voluntarily accept and assume the risk of injury to the minor or damage to the minor's property.
It is understood that the DOO does NOT provide any insurance coverage for the minor's person or property; and minor's parent(s) or guardian(s) acknowledge that they are responsible for the minor's safety and the rninor's own health care needs, and for the protection of the minor's property.
In exchange for allowing the minor to participate in these KOA activities and events, the minor by and through the undersigned, agrees to release from liability, agree to indemnity, and hold harmless the KOA, and any KOA agent, officer or KOA employee acting within the scope of their duties, for any injury to the minor's person or damage to the minor's property.
This Release shall be binding upon the minor, the parent(s) or guardian(s), any successors in interest, and/or any person(s) suing on the minor's behalf.
The minor's parent(s) or guardian(s) understand that this document is complete unto itself and that any oral promises or representations made to them concerning this document and/or its terms are not binding upon the KOA, its officers, agents and/or employees.
I, the undersigned, do hereby state that I have not altered or tampered in any way with the contents or wording of this contractual waiver.
PARENT OR LEGAL GUARDIAN MUST SIGN BELOW:
I, the undersigned, state that I am the parent or legal guardian of the minor whose name appears above. I understand that the above terms and conditions apply to said minor and to myself. I further understand that said minor cannot participate under ANY circumstances in any combat-related activities without parental consent where such participation is allowed by kingdom rules. The minor will not be able to participate in any KOA activities without entering into this agreement. This document is binding on myself the said minor, and any person suing on behalf of said minor.
Birth date of minor: ________________ Age of minor: ___________ Home State of minor: _____________________
Parent/Guardian Legal Name (PRINT): ____________________________________
Parent/Guardian Legal Name (SIGN): _____________________________________
CERTIFICATE OF ACKNOWLEDGEMENT
__________________________
On _____________________ before me, (NOTERY) ___________________________________________________
personally appeared to me (or proved to me on the basis of satisfactory evidence, to be the citizen(s) whose name(s) is/are subscribed to within the instrument and acknowledged to me that he/she/they executed the same in his/her/their individual capacity(ies), and that his/her their signature(s) on the instrument, are the said person(s), or the entity upon behalf of which the citizen(s) acted, execute the instrument.
________________________________________________________ NOTARY SEAL
Notary's Signature