HEARTLAND COMMUNITY ASSOCIATION

ACTIVITIES

Release and Indemnification Form – Child

Event _____________________________________      Date of Event _______________

Name of participant _______________________________________________________

Address ___________________________________   TX     Zip ____________________

Contact Information _________________________   Alternate _____________________

I, the parent or guardian of the above named Child Participant, am eighteen years of age or older and have volunteered the Child Participant to participate in the sports club activity listed above (the “Activity”).  I acknowledge that the nature of the activity may expose the Child Participant to hazards or risks that may result in the Child Participant’s illness,   personal injury or death and I understand the nature of such hazards and risks.

In consideration of the Child Participant’s participation in the Activity, I hereby accept all risk to the Child Participant’s health and of the Child Participant’s injury or death that may result from such participation and I hereby release Heartland Community              Association, Kaufman County MUD 8-11 Board, Hillwood Residential, Vista Church, and Capital Consultants Management Corporation (the “Community”), its governing board, officers, employees and representatives from any and all liability to me or the Child     Participant, the Child Participant’s personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to the Child    Participant’s property and for any and all illness or injury to the Child Participant’s      person, including the Child Participant’s death, that may result from or occur during the Child Participant’s participation in the Activity, whether caused by negligence of the Community, its governing board, officers, employees, or representatives, or otherwise.  I further agree to indemnify and hold harmless the Heartland Community Association and its governing board, officers, employees, or representatives from liability for the injury or death of any person(s) and damage to property that may result from the Child Participant’s negligent or intentional act or omission while participating in the described Activity. I also give    Heartland Community Association and Hillwood Residential permission to use my photograph for attended events in their promotional and/or Association publications.

I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR THE CHILD PARTICIPANT’S INJURY OR DEATH OR DAMAGE TO THE CHILD          PARTICIPANT’S PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED ACTIVITY AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY THE CHILD PARTICIPANT’S NEGLIGENT OR INTENTIONAL ACT OR OMISSION.

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Signature of Parent or Guardian                                                                                       Date

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Signature of Participant                                                                                                      Date