Release of Liability and Permission Regarding Medical Care
I acknowledge that I have freely and voluntarily chosen to participate in an equipping program operated by Forge. It is my understanding that participation in this program is a privilege. In consideration for the privilege of participating in this program, I am signing this Release of Liability and Permission Regarding Medical Care form (“Release”). I acknowledge that my participation in this Forge sponsored Equipping Program may involve certain risks of physical or mental injury, illness, death, or loss or damage to my property, including risks of which I may not presently be aware and I hereby agree to assume such risks.
2. Release and Indemnification
I hereby agree to release and hold harmless FORGE, members of its board of directors, and its officers, employees, members, volunteers and agents (collectively, the “Released Parties”), from, and to discharge and waive, any and all claims, demands, losses, damages and liabilities with respect to any and all property damage, personal injury, and/or death arising from my participation in a Forge sponsored Equipping Pro-gram. The foregoing sentence shall apply (without limitation) to all claims, demands, losses, damages and liabilities described therein, whether known or unknown, foreseen or unforeseen, future or contingent, except claims, demands, losses, damages and liabilities arising out of the sole and exclusive gross negli-gence or willful and wanton misconduct of one or more of the Released Parties. I further covenant not to sue any of the Released Parties in connection with any of the claims, demands, losses, damages or liabili-ties described above.
I further agree to indemnify, save and hold harmless the Released Parties from any and all claims, de-mands, losses, damages and liabilities for indemnities, contribution or otherwise, as may be asserted by a third party (defined as an party other than the Released Parties or me), with respect to any and all prop-erty damage, personal injury and/or death arising from the attributable to my participation in a Forge sponsored Equipping Program, except to the extent such property damage, personal injury and/or death is attributable to the action or inaction of one or more of the Released Parties or a third party.
3. Authorization for Medical Care
I understand and acknowledge that FORGE does not provide health insurance for me, except for travel insurance which FORGE may, in its sole discretion, choose to obtain. I agree that it is necessary for me to maintain insurance. I herby certify that I am covered by a personal or group insurance plan, the policy name and number of which I have listed below, for hospitalization and medical expenses.
In case I am in need of any necessary medical or surgical treatment to protect my health and welfare while participating in a Forge sponsored Equipping Program, I authorize and agree to allow any author-ized agent or employee of FORGE to consent to and authorize the administering of any such necessary medical and/or surgical treatment. I acknowledge and agree that the release of liability, hold harmless and indemnification provisions set forth in Section 2 above shall apply to any authorization and consent to medical or surgical treatment on my behalf made by FORGE or its authorized agents or employees. I further agree to be personally responsible for all costs of medical treatment and services, including emergency services, as may be authorized by an authorized agent or employees of FORGE.
In the event any provision of this Release is determined to be invalid for any reason, such invalidity shall not affect the validity of any of the other provisions, which other provisions shall remain in full force and effect as if this Release had been executed with the invalid provision eliminated. I understand and agree that this Release is intended to be as broad and inclusive as permitted under applicable law.
The undertakings and covenants of this Release shall be binding upon me, my family, my heirs, next of kin, legal representatives, beneficiaries, successors, and assigns. This Release shall be interpreted in ac-cordance with the laws of the State of Colorado. The terms of this Release are contractual and not a mere recital.
This Release shall be effective and binding upon me. I have read this Release and understand its terms. I further represent I am at least (18) years of age and am not a minor in the State of residence or, if I am a minor in such State, that my parents or guardian have signed below.
By signing below, I acknowledge that I have read this "Release of Liability and and Authorization Regarding Medical Care" and agree to release Forge ("Forge") and other parties from liability. I am also granting permission to Forge to seek and obtain medical care in the event of my illness or injury. I have therefore been advised to read the above document carefully.