SUBMIT WAIVER

Current Waiver Status: None

It looks like you haven't submitted a waiver yet. In order to participate in Hearthlight events, you must submit a waiver using the form below.

Current Waiver Status: Expired

Your waiver expired 3/10/2019. You just submit a new waiver before you can continue participating in Hearthlight events.

Current Waiver Status: Active

Your waiver will expire 6/9/2019. You can extend this deadline any time by submitted a new waiver below.

Submit a New Waiver

CONSENT TO PARTICIPATE AND RELEASE LIABILITY

I, the undersigned, do hereby state that I wish to participate in activities sponsored by the organization known as Hearthlight, Inc., a Delaware not-for-profit corporation. Hearthlight has rules which govern and may restrict the activities in which I can participate. These rules include, but are not limited to: the bylaws and the Rules for combat related activities.

 

Hearthlight makes no representations or claims as to the condition or safety of land, structures or surroundings, whether or not owned, leased, operated or maintained by Hearthlight.

I understand that all activities are VOLUNTARY and that I do not have to participate unless I choose to do so. I understand that these activities are potentially dangerous or harmful to my person or property, and that by participating I voluntarily accept and assume the risk of injury to myself or damage to my property.

I understand that Hearthlight does NOT provide any insurance coverage for my person or my property. I acknowledge that I am responsible for my safety and my own health care needs, and for the protection of my property.

In exchange for allowing me to participate in Hearthlight activities and events, I agree to release from liability, agree to indemnify, and hold harmless Hearthlight and any Hearthlight agent, officer, or Hearthlight employee acting within the scope of their duties, as well as other participants in activities sponsored by Hearthlight, for any injury to my person or damage to my property.

This Release shall be binding on myself, successors in interest, and/or any person(s) suing on my behalf.

I have read the statements in this document. I agree with its terms and have voluntarily signed it. I understand that this document is complete unto itself and that any oral promises or representations made to me concerning this document and/or its terms are not binding upon Hearthlight, its officers, agents, employees or participants.

 

I UNDERSTAND THAT THIS IS A LEGAL DOCUMENT. I HAVE READ AND UNDERSTOOD THIS RELEASE AND I UNDERSTAND ALL ITS TERMS. I EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS MEANING AND SIGNIFICANCE. ​

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Date:

05/18/2021

By checking this box you agree to the above & verify the information provided is valid.

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