Signup

Guma i Sindalu Siha – Accident Waiver and Release of Liability

Participant Name: {name}
Date of Birth: {dob}
Address: {address}
Phone Number: {phone}
Emergency Contact Name: {contact_name}
Emergency Contact Phone: {contact_phone}
Emergency Contact Relationship: {contact_relation}
Date Signed: {sign_date}

I, {name}, hereby acknowledge that I am voluntarily participating—or I am the parent or legal guardian of a minor participant—in activities hosted by Guma i Sindalu Siha, LLC located at 458 S Marine Corps Dr. Unit WH-2, Tamuning, GU 96913.  I ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH, INSIDE, OUTSIDE AND ON THE PROPERTY AT 458 S Marine Corps Dr. Unit WH-2, Tamuning, GU. 96913 including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.  

I acknowledge that participating in regular and extreme sports stunts and obstacles including but not limited to; ninja warrior obstacle courses, fitness training, flips, jumps, salmon ladders, ropes, rings, warped walls, peg boards, weights, obstacles, other athletic or recreational activities that involve physical exertion and coordination, etc. is extremely dangerous and minor physical injuries while participating in any of these or similar types of activities is common. Catastrophic injuries are rare; however, we feel that our guests should be aware of the possibility. These injuries can include strains, sprains, broken bones, spinal injuries, paralysis, stroke, heart attack, permanent disabilities and even death.  

PARTICIPANT CERTIFICATION

I certify that I (or the minor for whom I am responsible) am in good health, physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.   

ASSUMPTION OF RISK

I understand that participating in any physical activity or using gym equipment involves potential risks. These risks may result from actions, inactions, or negligence of myself or others, including but not limited to staff, volunteers, other participants, and third-party service providers.

I also acknowledge risks from the condition of the facilities, terrain, equipment, and potential environmental or vehicular hazards. I voluntarily accept all such risks.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the owners and habitants of  458 S Marine Corps Dr. Unit WH-2, Tamuning , GU. 96913 of the activity in which I may participate , and that it will govern my actions and responsibilities at said activity .     

WAIVER AND RELEASE OF LIABILITY

PHOTO & MEDIA RELEASE

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the owners, activity holders, producers, sponsors, organizers, and assigns.  

CONSENT TO TREATMENT

In the event of an injury or medical emergency, I authorize the staff of Guma i Sindalu Siha to seek and consent to emergency medical treatment on my behalf or on behalf of the minor named above.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law .     

If signing for a minor, I affirm that I am the minor’s parent or legal guardian and have full authority to execute this release on their behalf.

Signature of Participant or Legal Guardian:
Date Signed: {sign_date}
Initials: