A special event waiver sign for the iPad is a pass to participate in the event.

INDIVIDUAL PARTICIPANT RELEASE/WAIVER/INDEMNITY AGREEMENT

The undersigned (“Participant”) agrees as follows, for the benefit of Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, the Permanente Medical Groups, and other entities participating in the Kaiser Permanente Medical Care Program (collectively “Kaiser Permanente”):

1. Participant wishes to participate in the event, Kaiser Permanente – GSW Basketball Activation, Thrive Challenge Activation – an activity sponsored or funded in part by one or more entities of Kaiser Permanente.

2. Participant understands that Kaiser Permanente’s role is limited to a contribution of money, goods, labor, or other assistance and that Kaiser Permanente is not responsible for the organization of the details of the event nor for measures (if any) that may have been taken to assure the safety of participants in the Event.


3. Participant has voluntarily decided to participate in the Event; as a condition to Participant participating in the Event, Kaiser Permanente requires Participant to sign and deliver this Agreement; and, except as set forth in this Agreement, Kaiser Permanente has made no representation or warranty, express or implied, of any kind whatsoever relating to the subject matter of this Agreement.

4. PARTICIPANT RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO COMMENCE LEGAL ACTION AGAINST KAISER FOUNDATION HEALTH PLAN, INC., KAISER FOUNDATION HOSPITALS, THE PERMANENTE MEDICAL GROUPS AND EACH OF THEIR OFFICERS, EMPLOYEES, AFFILIATES, OR AGENTS (THE “RELEASED PARTIES”) FROM ANY AND ALL CLAIMS, DAMAGES, LIABILITIES, COSTS AND EXPENSES, INCLUDING ATTORNEYS’ FEES, RESULTING FROM OR IN ANY WAY RELATED TO ANY DEATH, BODILY INJURY OR PROPERTY DAMAGE INCURRED AT, CONNECTED WITH OR AS A RESULT OF THE EVENT, WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

5. Participant shall indemnify, defend and hold harmless the Released Parties from and against any and all claims, damages, liabilities, costs and expenses, including attorneys’ fees, that the Released Parties may incur in connection with, as a result of or in any way related to Participant’s participation in the Event, except such claims caused by the sole negligence of the Released Parties.

6. PARTICIPANT VOLUNTARILY AND WITH FULL KNOWLEDGE OF THE RISKS,  ASSUMES FULL AND COMPLETE RESPONSIBILITY FOR, AND RISK OF, DEATH, BODILY INJURY AND/OR PROPERTY DAMAGE RESULTING FROM, CONNECTED WITH, OR IN ANY WAY RELATED TO PARTICIPANT’S PARTICIPATION IN THE EVENT.

7. Participant’s participation in the Event shall not make Participant an agent, partner, or any other such legal status that legally could bind Kaiser Permanente as a result of Participant’s action; and, Participant shall have no authority whatsoever to bind Kaiser Permanente in any way.

8. This Agreement is a contract made under the laws of the State of California and shall be construed and enforced in accordance with the laws of such state.

9. This Agreement is binding upon and inure to the benefit of the parties hereto, the Released Parties, their heirs, executors, successors and assigns.

10. In the event any provision of this Agreement is held invalid, the remaining portions of the Agreement shall remain in full force and effect. The release, waiver and indemnity provisions contained in this Agreement are intended by the parties to be as broad and inclusive as permitted by law and shall be interpreted accordingly.


11. I waive any right to approve: 1) the finished photographs, Images, audio recordings and/or statements made by me, and any marketing materials or other printed, video or digital matter that may be used in connection with my name, Images, audio recordings, statements and/or Creative Works; and 2) the eventual use of any of the foregoing. I acknowledge that KP owns all rights in the photographs, Images, audio recordings and/or statements made by me and I waive any claims that I have or may have based on its usage of them or any works derived from them.


IN WITNESS WHEREOF, the undersigned has executed this Agreement as date listed below.

Click to sign
Please sign here.
Please enter your full name.
Please enter valid date.

If under 18 years of age, parent(s) or legal guardian(s) must sign below.

The undersigned, the parent(s)/legal guardian(s) of Participant, has (have) reviewed this Agreement and  consent(s) and agree(s) to this Agreement.

Click to sign
Please sign here.
Please enter your full name.
Please enter valid date.