You may download, complete, and return this pdf file or complete the on-line version below.

Adult Athletic Release & Hold Harmless

INTENDING TO BE LEGALLY BOUND HEREBY, and in consideration of the permission herein granted, the undersigned agrees to indemnify and hold harmless St. Alphonsus Parish of Wexford, PA, the Bishop of the Roman Catholic Diocese of Pittsburgh, their officers, agents and employees, from any and all liability for personal injuries (including death) and property damage occasioned by, or in any way connected with the use of the gym facilities, or property of said parish by the undersigned. The undersigned further agrees to abide by all the rules and regulations promulgated by St. Alphonsus Parish of Wexford, PA Parish for its athletic facilities.

As additional consideration for the permission granted, and INTENDING TO BE LEGALLY BOUND HEREBY, I, for myself, my heirs, and my legal representatives, RELEASE AND FOREVER DISCHARGE St. Alphonsus Parish of Wexford, PA, and the Roman Catholic Diocese of Pittsburgh, their successors and legal representatives, of and from ANY AND ALL CLAIMS, DEMANDS, RIGHTS, AND CAUSES OF ACTION OF WHATEVER KIND AND NATURE, arising from, and by reason of any and all known and unknown, foreseen and unforeseen personal injuries (including death) and property damages that I may sustain as a result of, or in any way related to my use of the above described premises.

I understand that checking the acceptance box below and entering my full name is a legal substitute for a written signature.

Signature:   Date:

Email: Telephone:  

Spambot protection: captcha

Please enter the above characters in this box:  

Thank you. When you click the submit button below, a copy of the form will be returned to you via e-mail.