MEDICAL WAIVER, INDEMNITY AND CONSENT FORM
The organisers are DX which is a part of the group of companies under Xtreme Adrenalin ltd and this agreement covers any person, body or organisation that is connected with the sessions paid or unpaid.
In consideration of DX allowing the Participant to take part in the sessions. Participant hereby agrees as follows:
1. I acknowledge that (i) the Session can be/are physically strenuous and my completion of this form confirms that I have read and reviewed the details of what participation in the sessions entails as described (ii) participation in the sessions will be physically demanding and may involve, but is not limited to, various modes of physical activity including Ice Hockey and possible, ice skating and body contact (iii) I am aware of and accept the various medical, physical and emotional risks which are inherent in such activities and, it is my responsibility to take rest where possible.
2. I confirm that I have answered the following questions in advance of attending the Event/s and in the instances where I have answered “yes” to any of the questions, I have sought medical advice as to my participation in the Sessions and informed DX of the complaint or condition, : –
We reserve the right to prevent the participant attending from the session should we deem it necessary.
I hereby confirm that I am physically capable of competing in the sessions. If, at any time hereafter, I develop or discover any medical or physical limitation or condition (including, but not limited to, those listed above) that might affect my ability to safely participate in the sessions, or meet the physical demands required thereof, I agree to make such limitations and conditions immediately known to DX and to cease participating in the sessions. DX recommends that each Participant should seek medical advice as to his/her participation in the sessions. We recommend personal accident insurance as DX insurance policies, has no coverage for this but only coverage for claims of one player against another player – public liability is covered to £5 Million and I acknowledge that I have read and understood this recommendation.
3. I hereby represent that I am participating in the sessions voluntarily, with full knowledge of the potential risks entailed and that I am expressly, knowingly and voluntarily assuming the risk of any and all physical or emotional injury associated with or caused by my participation in the sessions.
4. In view of the foregoing, and as a term and condition of participating in the sessions, I hereby release, discharge and hold harmless, for myself and my heirs, executors, administrators and assigns, DX, its staff and contractors, participating sponsors, venues and charities, and each of their respective parents, subsidiaries, affiliates, advertising and promotion agencies and medical advisors, and each of the officers, directors, shareholders, employees, and agents of the foregoing (collectively, the “Released Parties”), from and in respect of any injury or illness that I may suffer as a result of my participation in the Event.
5. I hereby accept total responsibility for the condition and maintenance of any equipment I bring to the sessions including any purchased through DX. I hereby release, discharge and hold harmless, for myself and my heirs, executors, administrators and assigns, DX and the Released Parties, from and in respect of any loss of or damage to any equipment which occurs travelling to and from and during the Event.
6. The information you provide on this form will be held in accordance with the Data Protection Act 1998.
PARTICIPANT’S MEDICAL WAIVER, INDEMNITY AND CONSENT FORM ./….
8.1. irrevocably consent to my appearance in the sessions being filmed, recorded, incorporated, edited, used disseminated, adapted, modified, copied and exploited in whole or in part in any television programme, film, video or broadcast of whatever nature by all means and in all media and formats now known or subsequently invented after the date shown below; and
8.2. irrevocably consent to the use and reproduction by DX and its designees of my name, likeness, appearance in photographs, films and recordings by all means and in all media throughout the world in perpetuity and for no additional compensation (unless prohibited by law) for the purpose of advertising, publicity and otherwise in relation to the exploitation of the sessions and/or the promotion of the sessions and the exploitation of the commercial rights relating to the sessions provided that such use does not imply my direct endorsement of any third party including any official sponsor or supplier of the Event; and
8.3. warrant that I am at least 18 years of age and have the full right and power to enter into this Medical Waiver and Consent Form and that the terms of this document do not in any way conflict with any existing commitment on my part.
9. I hereby acknowledge and agree:
9.2. DX shall not be liable for:
9.2.1. any loss or damage of personal equipment belonging to me
9.2.2. any indirect or consequential losses
suffered or incurred by me arising out of me taking part in the Event or any other matter arising under these Conditions of Entry in any case whether or not such losses or damage were within the contemplation of the parties at the date my employer submitted the Entry Form.
10. Nothing in this Participant’s Medical Waiver and Consent Form shall exclude or limit the liability of DX for death or personal injury caused by DX negligence, for fraud or fraudulent misrepresentation, or for any matter for which it would be illegal for DX to exclude or attempt to exclude its liability.
11. I agree that this Medical Waiver and Consent Form supersedes any prior understanding between myself and relating to the rights granted herein and no provisions of this Medical Waiver and Consent Form