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REGISTRATION INFORMATION
REGISTRATION INFORMATION

Western DuPage Special Waiver and Release of All Claims
Recreation Association and Assumption of Risk

Please read this form carefully and be aware that in the signing
and participating in this program/activity, you will be expressly
Important Information assuming the risk and legal liability and waiving and releasing
The Western DuPage Special Recreation Association (WDSRA) all claims for injuries, damages, or loss which you or your
is committed to conducting its recreation programs and activities minor child/ward might sustain as a result of participating in
in a safe manner and holds the safety of participants in high any and all activities connected with and associated with this
regard. WDSRA continually strives to reduce such risks and program/activity (including transportation services, when
insists that all participants follow safety rules and instructions provided).
that are designed to protect the participants' safety. However,
participants and parents/guardians of minors for this program/ I recognize and acknowledge that there are certain risks of
activity must recognize that there is an inherent risk of injury physical injury to participants in this program/activity, and I
when choosing to participate in recreational activities. voluntarily agree to assume the full risk of any and all injuries,
damages or loss, regardless of severity, that my minor
You are solely responsible for determining if you or your child/ward may have (or accrue to me or my child/ward) as a
minor child/ward are physically fit and /or skilled for activities result of participating in this program/activity against
contemplated by this agreement. It is always advisable, especially WDSRA, including officials, agents, volunteers and employees
if the participant is pregnant, disabled in any way, or recently (hereinafter collectively referred as WDSRA).
suffered an illness, injury, or impairment, to consult a physician
before undertaking any physical activity. I do hereby fully release and forever discharge WDSDA from
any and all claims for injuries, damages, or loss that my minor
child/ward or I may have or which may accrue to me or my
Warning of Risk minor child/ ward and arising out of, connected with, io in
Despite careful and proper preparation, instruction, medical any way associated with this program/activity.

advice, conditioning, and equipment, there is still a risk of serious In the event of an emergency, I understand and authorize
injury when participating in any recreational activity/program. WDSRA staff and officials to secure from any licensed hospital,
Understandably, not all hazards and dangers can be foreseen. physician and/or medical personnel any treatment deemed
Participants must understand that certain risks, dangers, and necessary for immediate care for myself or minor/ward and
injuries due to acts of God, inclement weather, slipping, falling, agree that I will be responsible for payment of any and all
equipment failure, failure in supervision, premise defect, and medical services rendered.
all other circumstances inherent to recreational activities/
programs exist. In this regard, it must be recognized that it is
impossible for WDSRA to guarantee absolute safety. Photo/Video Release
I hereby authorize and give my consent to WDSRA to
Connect With Us! photograph/video my child (or me) or to obtain outside
photographs/video of my child (or me) participating in
WDSRA activities/events/programs, and without limitation,
to use such photographs/video in connection with promoting/
advertising the services, programs, and facilities of WDSRA,
without consideration of any kind.

You must sign and date the bottom of the reverse side of this form before your registration can be processed. Participation
will be denied if the signature of adult participant or parent/guardian and date are not on the front of this waiver

REGISTER ONLINE AT WWW.WDSRA.COM 41