Guest First Name (required)
Last Name (required)
Street (required)
City (required)
State (required)
Zip Code (required)
First Name (required)
Emergency Contact First Name (required)
Emergency Contact Last Name (required)
Main Phone (required)
CellHomeWork
Alternative Phone
Primary Email (required)
I hereby acknowledge that I understand and agree to abide by the Mt. Park HOA Clubhouse Rules and understand that there are inherent risks of accidents with certain facilities and activities that may result in bodily harm or property damage. I acknowledge that I am responsible for the actions of any minors listed above and, if I am the legal owner of the household, for the actions of any residents or guests of my household. I understand that recreational activities are planned with the safety of the participants in mind. I acknowledge that I and any minors listed above have the physical capacity reasonably necessary to engage in recreational activity for which I (we) have enrolled. I agree to be the party responsible for all medical expenses which are incurred on my behalf or on behalf of any minors listed above. I understand and agree to release, indemnify, hold harmless, and defend Mountain Park Home Owners Association, Boards, employees, volunteers, and agents against all claims, including claims of negligence or failure to act, damages, loss, or expenses including attorney’s fees or costs arising out of or resulting from my participation or participation by any minors listed above in recreational programs. I acknowledge and agree that this waiver may be executed by electronic or digital signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.
Signature (required)
Date (required)
