THIS IS A RELEASE OF LIABILITY. I and each of a minor child's parents or guardians, acknowledge that there are inherent risks and hazards associated with sports and group activities and that I/my child may be subject to serious or fatal injury from these activities and that I/my child may be exposed to bodily injury and other damages which may be attributable to the character of the activity. In consideration of being a participant in the activities of the Town of Berthoud, I hereby freely assume all risks in connection with this activity and hereby agree to release indemnify, defend and hold harmless the Town of Berthoud and all of its employees, agents and officers and waive any and all claims of damage arising from injury or loss received by the participant involved in this activity whether due to negligent acts or omissions of said parties, other participants, or otherwise. I further realize and acknowledge that emergency medical treatment and hospitalization may be necessary for myself/my child because of my/my child's participation in this activity and I hereby authorize the Town of Berthoud, its agents or employees in their sole discretion to arrange for such medical treatment and hospitalization for myself/my child at my sole cost without further consent. This release shall remain in effect until a written revocation is received by the Town Clerk of the Town of Berthoud.

I CERTIFY THAT I HAVE READ AND UNDERSTOOD THE  RELEASE OF LIABILITY. CHECKED BOX INDICATES SIGNATURE .