PARENTAL AUTHORIZATION / MEDICAL RELEASE
I, parent and/or legal guardian of the Participant, hereby give authorization for participation in any and all Junior Roller Derby Association League, Dallas Derby Devils, and Rolling Rebellion, LLC, activities. I hereby grant permission to managing personnel and league representatives to authorize and obtain medical care from any licensed physician, hospital or medical clinic, should the skater become ill or injured while participating in league activities when neither parent nor legal guardian is present to grant authorization for immediate treatment. I assume all risks and hazards incidental to such participation, including transportation to and from league activities, and do hereby waive, release, indemnify and agree to hold harmless the JRDA and any Junior League and its agents, assigns, representatives, officers and employees from any and all claims arising out of the skater’s participation in any and all league activities.
WAIVER OF LIABILITY, RELEASE
ASSUMPTION OF RISK & INDEMNITY AGREEMENT
It is the purpose of this agreement to exempt, waive and relieve releasees from liability for personal injury, property damage, and wrongful death, including if caused by negligence, including the negligence, if any, of releasees. “Releasees” include Dallas Derby Devils, and Rolling Rebellion, LLC, hereby referred to as HOST LEAGUE, its affiliate associations, local associations, member teams, event hosts, other participants, coaches, officials, sponsors, advertisers, and each of them, their officers, directors, agents and employees.
For and in consideration of the undersigned participant’s registration with HOST LEAGUE, its affiliates, local associations and member teams and being allowed to participate in events and member team activities, participant (and the parent(s) or legal guardian(s) of participant, if applicable) waive, release and relinquish any and all claims for liability and cause(s) of action, including for personal injury, property damage or wrongful death occurring to participant, arising out of participation in events, member team activities, the sport of roller derby, and/or activities incidental thereto, whenever or however they occur and for such period said activities may continue, and by this agreement any such claims, rights, and causes of action that participant (and participant’s parent(s) or legal guardian(s), if applicable) may have are hereby waived, released and relinquished, and participant (and parent(s)/guardian(s), if applicable) does(do) so on behalf of my/our and participant’s heirs, executors, administrators and assigns.
Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge, understand and assume all risks relating to roller derby and any member team activities, and understand that roller derby and member team activities involve risks to participant’s person including bodily injury, partial or total disability, paralysis and death, and damages which may arise therefrom and that
I/we have full knowledge of said risks. These risks and dangers may be caused by the negligence of the participant or the negligence of others, including the “releasees” identified below. These risks and dangers include, but are not limited to, those arising from participating with bigger, faster and stronger participants, and these risks and dangers will increase if participant participates in roller derby and member team activities in an age group above that which participant would normally participate in. I/We further acknowledge that there may be risks and dangers not known to us or not reasonably foreseeable at this time.
Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge, understand and agree that all of the risks and dangers described throughout this agreement, including those caused by the negligence of participant and/or others, are included within the waiver, release and relinquishment described in the preceding paragraph. I/We agree to abide by and be bound under the rules of HOST LEAGUE, including the By-Laws of the corporation and the arbitration clause provisions, as currently published. Copies are available to HOST LEAGUE members upon written request.
Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge, understand and assume the risks, if any, arising from the conditions and use of roller derby rinks/facilities and related premises and acknowledge and understand that included within the scope of this waiver and release is any cause of action (including any cause of action based on negligence) arising from the performance, or failure to perform, maintenance, inspection, supervision or control of said areas and for the failure to warn of dangerous conditions existing at said rinks, for negligent selection of certain releasees, or negligent supervision or instruction by releasees.
If the law in any controlling jurisdiction renders any part of this agreement unenforceable, the remainder of this agreement shall nevertheless remain enforceable to the full extent, if any, allowed by controlling law. This agreement affects your legal rights, and you may wish to consult an attorney concerning this agreement.
Participant (and participant’s parent(s)/guardian(s), if applicable) agree if any claim for participant’s personal injury or wrongful death is commenced against releasees, he/she shall defend, indemnify and save harmless releasees from any and all claims or causes of action by whomever or wherever made or presented for participant’s personal injuries, property damage or wrongful death.
Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge that they have been provided and have read the above paragraphs and have not relied upon any representations of releasees, that they are fully advised of the potential dangers of roller derby and understand these waivers and releases are necessary to allow amateur roller derby to exist in its present form. Significant exclusions may apply to HOST LEAGUE’s insurance policies, which could affect any coverage. For example, there is no liability coverage for claims of one player against another player.
The Junior Roller Derby Association (JRDA) and Rolling Rebellion, LLC (Rolling Rebellion), has adopted the following inclusion and gender definition policy, modeled on the Men's Roller Derby Association Non-Discrimination Policy (http://www.mensrollerderbyassociation.com/resources/mrda-nondiscrimination-policy/). The JRDA and Rolling Rebellion, pursuant to its mission of promoting junior roller derby, does not and will not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, citizenship, or military status, in any of its activities or operations. These activities include, but are not limited to, membership eligibility, disbursement of resources, and eligibility for office. JRDA and Rolling Rebellion are committed to providing an inclusive and welcoming environment for all skaters, officials, volunteers, and fans.
JRDA and Rolling Rebellion do not and will not differentiate between members who identify as male/female and those who identify as a non-binary gender (including but not limited to genderqueer, transmasculine, transfeminine, and agender). JRDA and Rolling Rebellion do not and will not set minimum standards of masculinity or femininity of its membership or interfere with the privacy of its members for the purposes of charter eligibility. The presence of a skater on a gender-specific charter is the only required evidence of that skater's gender identity for JRDA and Rolling Rebellion play.
In the event a JRDA or Rolling Rebellion member allegedly violates the Non-Discrimination Policy, notice must be given to JRDA and Rolling Rebellion with details of the complaint. JRDA and Rolling Rebellion will investigate and take appropriate actions.
PHOTO & VIDEO RELEASE
For consideration which I acknowledge, I irrevocably grant to Rolling Rebellion, LLC, licensees, assigns and successors the right to use my image and (skater) name in all forms of media including composite or modified representations for all purposes, including advertising, trade or any commercial purpose throughout the world and in perpetuity. I waive the right to inspect or approve versions of my image used for publication or the written copy that may be used in connection with the images I relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed material that may be used in conjunction therewith or the use to which it may be applied. I release licensees, assigns and successors from any claims that may arise regarding the use of my image including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. Rolling Rebellion, LLC, is permitted, although not obligated, to include my name as a credit in connection with the image. I have read and understood the photo release agreement.
I (the undersigned) do hereby confirm the consent heretofore given you with respect to your photographing me or my child in connection with any Rolling Rebellion, LLC video or documentary. Additionally I hereby grant to you, your successor, assigns and licensees the perpetual right to use, as you may desire, all motion pictures and sound track recordings which you may make of me or my child, and the right to use my name and/or child's name or likeness in connection with the exhibition or any other use of such video or recording.
I am over eighteen years of age.
I HAVE READ AND UNDERSTAND THE PARENTAL AUTHORIZATION / MEDICAL RELEASE, WAIVER OF LIABILITY RELEASE ASSUMPTION OF RISK & INDEMNITY AGREEMENT, VIDEO & PHOTO RELEASE, NON-DISCRIMINATION POLICY, AND POSITIVE INVOLVEMENT CODE OF CONDUCT. I VERIFY THAT I HAVE COMPLETED THIS FORM AND THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. I FURTHER AGREE TO ABIDE BY THE RULES/GUIDELINES SET FORTH BY THE JUNIOR ROLLER DERBY ASSOCIATION AND THE ROLLING REBELLION, LLC.