Waiver and Release of Liability

(Minors must have notarized signature of Parent/Legal Guardian)

If for a minor, you will have to fill this form out in it's entirety,submit AND print it out, and turn in a notarized copy.

Your Real Name*

Enter your full real name

DOB*

Enter your date of birth

Address*

Enter your address

Phone Number*

Enter your best contact number

Email*

Enter your email address

Emergency Contact*

Full Name of your Emergency Contact

Emergency Contact Phone Number*

Enter your Emergency Contact Number

Do you have any serious health issues?*

Please list any you may think are relevant to your participation in Brackish Bay events

Character / Battle Name*

Enter your Character / Battle Name

Realm*

Enter your home realm if applicable, enter N/A if none.

Unit*

Enter your unit name if applicable, enter N/A if none.

Complete this section if the participant is a minor:

ADULT POINT OF CONTACT FOR MINOR: The following adult will serve as a point of contact regarding issues that may arise between the event organizers and the minor named above. The listed adult accepts no responsibility, liability or accountability for the minor named above.

Adult Name

Name of Authorized Parent or Guardian

Adult signature

Signature of Authorized Parent of Guardian

Character / Battle Name

Character / Battle Name of Authorized Parent or Guardian if applicable, enter N/A if none.

DOB

Date of Birth of Authorized Parent or Guardian

Realm

Realm of Authorized Parent or Guardian if applicable, enter N/A if none.

Unit

Unit of Authorized Parent or Guardian if applicable, enter N/A if none.

DESCRIPTION OF BRACKISH BAY:

Brackish Bay combines fast-paced full-contact combat simulation with elements of live action role-playing. Combat in group melees or between individuals is similar to the battle scenes in movies like Braveheart and Gladiator, with the biggest difference being that Dagorhir "weapons" are well padded to prevent injuries. Weapons are constructed to resemble Dark Age/medieval swords, shields, spears, etc. and generally consist of soft foam layers bonded to a rigid core. Combatants may also become involved in grappling/wrestling. Dagorhir rules of combat are strictly enforced by the Heralds (referees) to ensure maximum safety along with maximum playability. As with any outdoor, intense contact sport, the possibility for injury exists. The types and likelihood of injury are similar to those in soccer, rugby and lacrosse and, as in those sports, severe injuries can occur. By signing and accepting this waiver you understand that you are to adhere to the Brackish Bay Code of Conduct, and the Brackish Bay By-Laws at all times for the safety of you and your fellow participants.

WAIVER:

In consideration of receiving permission from Brackish Bay to participate in any Brackish Bay-sponsored activity, event, tournament, contest or meeting, the undersigned assumes full responsibility for any bodily injury and/or property damage arising out of or related to my attendance and/or participation. I fully release Brackish Bay, its members, participants, observers, officers, officials, owners and/or administrators of land upon which the event/activity is being held, and/or anyone administering emergency medical assistance from liability to myself, my assigns, heirs and next of kin for any injury to myself or damage to my property arising out of my attending/participating a Brackish Bay event/activity. I hereby agree that if at any time I feel any Brackish Bay activity/event to be unsafe or if I observe unsafe behavior on the part of other participants/observers, I will immediately notify the appropriate Brackish Bay officials and/or refuse to participate in or observe any further activities/events. The undersigned is aware of the risks and hazards inherent in participating in any activity, event, tournament, contest or meeting of Brackish Bay and elects voluntarily to participate, knowing that participation involves significant physical contact by others to his person and that such participation may entail a risk of injury. In signing this release, the undersigned acknowledges and represents:
(a) That he or she has read the above release, understands it, and signs voluntarily;
(b) That he or she is over 18 years of age and of sound mind;
(c) That, if the undersigned intends to participate in Brackish Bay activities, he or she has no known physical or mental defects that would increase the likelihood of serious injury from such participation;
(d) That, if signing on behalf of a Minor participant, the undersigned has the legal capacity to do so.

I, the Undersigned*

Type Full Name Here

Date of Signature*

Date of Signature or submission of this form

I, the Undersigned*

Sign your name here

Complete this section if you are signing for a minor:

Relationship to Minor

Parent, Legal Guardian, etc..

Phone Number

if different from minor

Address

If different from Minor

FOR OFFICIAL USE:

LEAVE BLANK AND USE IF PRINTED OUT

State of

Notary

City of

Notary

TO WIT:
I HEREBY CERTIFY that on this __________ day of ____________________, personally appeared and made oath in due form of law that the matters and facts set forth in the foregoing Agreement are true and correct as therein stated and that said Agreement is in fact his/her act and deed and that (s)he has full understanding thereof.

WITNESS my hand and Notarial Seal:

NOTARY PUBLIC

Notary Signature

SEAL

Notary Seal

My Commission Expires

fill in date