Text Box: RELEASE OF LIABILITY - - READ BEFORE SIGNING

In consideration of being allowed to participate in any way in the PINE CREEK OUTFITTERS, INC program, its
related events and activities, I, _____________________________, the undersigned, acknowledge, appreciate, 
and agree that:

The risk of injury from the activities involved in this program is significant, including the potential for
		permanent paralysis and death, and while particular skills, equipment, and personal discipline may 
		reduce this risk, the risk of serious injury does exist; and,

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF 
		ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility 
		for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation.  If however, 
		I observe any unusual  significant hazard during my presence or participation, I will remove myself from 
		participation and bring such to the attention of Pine Creek Outfitters, Inc. immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kind, HEREBY 
		RELEASE, INDEMNIFY,AND HOLD HARMLESS PINE CREEK OUTFITTERS, INC., their officers, 
		officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers,
 		and, if applicable, owners and lessors of the premises used for the activity (“Releasees”), 
		WITH RESPECT TO ANY AND ALL 	INJURY, DISABILITY, DEATH, or loss or damage to person 
		or property associated with my presence or participation, WHETHER ARISING FROM THE 
		NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY 
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, 
AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.



x______________________________________          Age:______           Date Signed: _____________
  (Participant’s Signature)

______________________________________
(Print Name)

______________________________________  _____________________        ____   _______
Address                                                                                 City                           State      Zip

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her 
release as provided above of all Releasees, and, for myself, my child and heirs, assigns, and next of kin, I release 
and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s 
involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF 
THE RELEASEES, to the fullest extent permitted by law.


X_________________________________     ______________________________        ________
PARENT/GUARDIAN’S SIGNATURE                     (print name)                                              date signed