Staff Sports Program
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Contact Information

 
First Name *

 
Last Name *

 
Employee ID # *

 
Phone Number

We (and the other captains) will need to know how to reach you!
 
Team Information

 
Choose A League *

Which sport is your team playing?

 
Team Name *

(Don't include "The" at the beginning of your name!)
 
Voluntary Employee Exercise Program Participant's Release/Waiver of Liability and Hold Harmless Agreement *

I, {{answer_nm2vQbgHNyEg}} {{answer_t2stSN4SgNzW}} (ID #{{answer_Piwiz8DBpCx9}}), have been informed and know the risks involved in participating in the voluntary staff sports program, and understand that serious injury, and even death, is possible in such participation and I choose to accept such risk. I voluntarily accept any and all responsibility for my own safety and welfare while participating in the employee exercise program, with the full understanding of the risks involved. I hold harmless and release the SCHOOL BOARD OF PALM BEACH COUNTY, FLORIDA, ITS MEMBERS, OFFICERS, EMPLOYEES, AGENTS and THIRD PARTY FACILITATORS, of any and all responsibility and liability for any injury or claim resulting from my participation in this event. 

In consideration for being allowed to participate in the employee exercise program, I for my heirs, executors and administrators, release and forever discharge the SCHOOL BOARD OF PALM BEACH COUNTY, FLORIDA, ITS REPRESENTATIVES, EMPLOYEES AND AGENTS of all liability, claims, actions, damages, and costs/expense I may have against them arising out of or in any way connected with my participation in the employee exercise program. I understand that this release /waiver of liability applies to any claim, even those based upon the direct negligence, actions or in actions of those referenced above, including the SCHOOL BOARD OF PALM BEACH COUNTY, FLORIDA. 

The undersigned participant's participation in the program is not a regular, direct or indirect condition of the participant's employment with the School Board. The undersigned participant has not been threatened, coerced, induced or promised anything whatsoever to participate in the Program, nor have there been any attempts by any person or entity to do so. Instead, the participant enters into this agreement of his/her own free will and acknowledges that this agreement is entered into in good faith on the part of the undersigned participant and the School Board. Further, the School Board expressly makes no request or requirement for the undersigned participant to participate in the Program, nor is participation in the Program a precondition to employment or continued employment with the School District. The School District receives no regular, direct or indirect benefit from the undersigned participant's involvement in the program, except for a possible improvement in the undersigned participant's health, welfare and morale that is common to all kinds of recreational and social activities. The undersigned participant's participation in the Program is purely voluntarily on the part of the undersigned participant, who understands his/her participation in the Program is not required either expressly or impliedly or otherwise by the School Board as an incident of the participant's employment with the School Board. The undersigned participant, therefore, when engaging in the Program, including but not limited to any travel related thereto, is not engaged in the course and scope of employment with the School Board. Further, the undersigned participant agrees not to accept and is not entitled to receive any wages, money or other compensation for employment with the School Board while engaging in or preparing to engage in the Program, including but not limited to, any travel related thereto.

I HAVE READ THIS CAREFULLY, UNDERSTAND IT, AND KNOW IT CONTAINS A RELEASE. I acknowledge that I have completed the Employee Exercise Physical Activity Readiness Questionnaire. If so indicated by the questionnaire, I agree to provide written release from a doctor before participating in the employee exercise program.


Activity: STAFF SPORTS PROGRAM                                                            LOCATION: PALM BEACH COUNTY SCHOOL DISTRICT   

Vendor Providing Activity/Services or Employee Organizing Activity:    RISK AND BENEFITS, IN PARTNERSHIP WITH BRIGHTLIFE
     
Thanks {{answer_nm2vQbgHNyEg}}!

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Sports Program Website