Release Form:
All riders MUST sign a release form before playing in the park.
All riders under the age of 18 MUST have NOTARIZED Parental Consent on file.
For your convenience we have attached a printable version of our release form below.
Minors must have a signed release form with them when entering the park without a parent
or guardian present.
ANNUAL CONVENANT NOT TO SUE, RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
LAST NAME______________________________________________FIRST_________________________________________________DOB___________________
THIS AGREEMENT APPLIES TO THE BURDENS CREEK ATV PARK CAMPING AND RECREATION AREA, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY.THIS AGREEMENT CONSTITURES AN EXPRESS CONTRACTUAL ASSUMPTION OF ALL RISKS, BOTH A WAIVER AND RELEASE OF LIABILITY FOR ANY NEGLIGENCE OR DANGEROUS CONDITION OF PRIVATE PROPERTY AND IDEMNITY FOR ALL THIRD PARTY CLAIMS [HEREINAFTER “AGREEMENT”]THE UNDERSIGNED FOR AND IN CONSIDERATION OF AND FURTHER FOR AND IN EXCHANGE OF BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD ALLOWING MY PAID USE OF THE PREMISES AS FOLLOWS:I KNOW THAT ATV, INCLUDING FOUR WHEELERS, MOTORCYCLES, THREE WHEELERS, DUNE BUGGY, DIRT BIKES, AND BICYCLE RIDING IS INHERENTALY DANGEROUS SPORTS AND RECREATION ACTIVITIES, IN WHICH I CHOOSE TO VOLUNTARILY PARTICIPATE AT MY OWN RISK. I AM AWARE THAT THE INHERENT AND USUAL GREAT RISKS, HAZARDS AND SUBSTANTIAL DANGERS OF PERSONAL INJURY, DEATH AND DISABLILTY OR PROPERTY DAMAGE AND LOSS FROM RIDING ATV’S, SUCH AS FOUR WHEELRS, THREE WHEELERS, MOTORCYCLES, DUNE BUGGY, DIRT BIKES AND BYCYCLES (COLLECTIVELY “DAMAGES”), NECESSAIRLY INCREASE WHEN I OR OTHERS USE RAMPS, TRAILS, TRACES, UNALTERED NATURAL TERRAIN, INCLINES OR DECLINES, MUD BOWLS, ROUGH EARTHERN TERRAIN AND ANY MANMADE AREA OR EARTHERN TERRAIN. I KNOW THAT THE INHERENT FORESEEN AND OFTEN UNFORESEEN RISKS, HAZARDS AND DANGERS INCLUDE, BUT ARE NOT LIMITED TO, MOTOR PROPELLED ATV’S AND BICYCLES WHICH CAN LEAD TO OR CAUSE STRAINS, BRUISES, BROKEN BONES, CONCUSSION, HEAT EXHAUSTION AND MANY OTHER INJURIES, DEATH AND PROPERTY DAMAGE RESULTING FROM FALLING OR BEING THROWN FROM THE ATV, WRECKING, JUMPING, LANDING, PREFORMING TRICKS, OR OTHER ACTIVITIES, AS WELL AS COLLIDING WITH OTHER OBJECTS, USERS, STAFF, BYSTANDERS OR SPECTATORS. I ALSO UNDERSTAND THAT THESE INHERENT, GREAT, INCREASED RISKS, HAZARDS, AND DANGERS ARE FUTHER INCREASED WHEN OTHER PERSONS, WHETHER OR NOT OF THE SOME LEVEL OF EXPERIENCE OR SKILL, ARE PRESENT AT THE SAME TIME AND USING THE SAME FACILITIES (“ALL OF THE ABOVE, DEFINED ACTIVITIES ARE COLLECTIVELY REFERRED TO THROUGHOUT THE AGREEMENT AS “THE HAZARDOUS RECREATIONAL ACTIVITIES”).
BY THIS AGREEMENT, IT IS MY INTENTION TO FOREVER RELIEVE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY AND ANYONE ASSOCIATED WITH AND WORKING FOR BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY INCLUDING, BUT NOT LIMITED TO , ITS OWNERS, LANDLORDS, OFFICERS, EMPLOYEES AND AGENTS, VOLUNTEERS, SPONSORS, VENDERS, CONTRACTORS AND EXHIBITORS OR ANY DUTY TO ME AND I DO ASSUME THE ENTIRE RISK OF FORESEEN OR UN FORESEEN, KNOWN OR UNKNOWN, BODILY AND PERSONAL INJURY, DAMAGES, LOSSES, HARMS, DEATHS, PROPERTY CLAIMS, MEDICAL EXPENSES, HOSPITAL EXPENSES AND ANY OTHER TYPE OF PERSONAL OR PROPERTY DAMAGE CLAIMS OR EXPENSES THAT MIGHT OCCOR DURING THIS AGREEMENT, I ALSO INTEND TO FOREVER RELEASE, DISCHARGE AND ABSOLVE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND, AND CANADIAN NATIONAL RAILROAD COMPANY FROM ANY AND ALL LIABILIATY FOR ANY ACTIVE OR PASSIVE NEGLIGENCE WHATSOEVER BY BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND, CANADIAN NATIONAL RAILROAD COMPANY AND TO WAIVE AND RELINQUISH ANY CLAIM, DEMAND OR CAUSES OF ACTION, OF WHATSOEVER KIND OR NATURE OR KNOW OR UNKNOWN, AGAINST BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY FOR ANY PROPERTY DAMAGE, LOSS, EXPENSE AND FOR ALL PERSONAL INJURY, DAMAGE, LOSS, HARM, DEATH, HOSPITAL EXPENSE OR ANY OTHER TYPE OF EXPENSE CAUSED BY ANY NEGILGENCE OF BURDENS CREEK ATV PARK, MAPPS FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY OR OTHER PERSONS USING THE RECREATION AREA AND PROMISE NOT TO SUE OR EXERCISE ANY LEGAL RIGHT TO SEEK DAMAGES FROM BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD, BY THIS AGREEMENT, I ALSO INTEND TO AND DO FOREVER RELEASE, DISCHARGE, WAIVE AND RELINQUISH AND ABSOLVE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD FROM ANY AND ALL CLAIMS OR CAUSES OF ACTTION AGAINST BURDENS CREEK ATV PARK , MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANYFOR ANY PROPERTY DAMAGES, LOSS OR EXPENSE AND PERSONIAL INJURY, DAMAGES, LOSS, HARM, DEATH, MEDICAL EXPENSES OR HOSPITAL EXPENSES AND ANY OTHER TYPE OF EXPENSE CAUSED BY THE HAZARDOUS RECREATIONAL ACTIVITIES AND /OR BY THE CONDITION AND /OR MAINTNANCE OF THE RECREATIONAL PREMISES OR ANY OF IT EQUIPMENT, STRUCTURES OR DIVISES INCLUDING BUT NOT LIMITED TO RAMPS, TRACES, UNALTERED TERRAIN, INCLINES OR DECLINES, MUD BOWLS, ROUGH NATURAL EARTHERN TERRAIN OR ANY MANMADE RIDING AREAS OR ALTERED TERRAIN AND PROMISE NOT TO SUE OR EXERCISE ANY LEGAL RIGHT TO SEEK DAMAGES FROM BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY FOR INJURIES OR DEATH RESULTING FROM AND ACTIVITY, OR ANY REASON WHATSOEVER OR FROM ANY INJURIES OR DAMAGES WHICH OCCOR AT THE RECREATION AREA.
IN CONSIDERATION OF BEING PERMITTED TO UTILIZE FOR PAY THE RECREATION AREA I AGREE AS FOLLOWS:AS TO MY PARTICIPATION IN ANY ACTIVITY, INCLUDING, BUT NOT LIMITED TO, THE HAZARDOUS RECREATIONAL ACTIVITIES AND AS SO ANY AND ALL LIABILITY AND FOR ANY INJURY OR DANAGES WHICH I MAY SUFFER OR INCUR DUE TO ANY CAUSE WHATSOEVER, WHILE ON THE RECREATION AREA PREMISES, I HEREBY AGREE:
TO FOREVER WAIVE ANY AND ALL CLAIMS FOR ANY INJURY AND /OR DAMAGES THAT I MAMY HAVE AGAINST BURDENS CREEK ATE PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY OR ANY OTHER PERSON, LANDLORD, COMPANY OR ENTITY IN ANY WAY ASSOCIATED WITH IT. _________________INITALS
TO FOREVER RELEASE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY FROM ANY AND ALL LOABILITY FOR ANY INJURY AND OR DAMAGES THAT I MAY SUFFER OR INCUR, OR THAT MY NEXT OF KIN MAY SUFFER, AS A RESULT OF MY
PARTICIPATION IN ANY ACTIVITY, INCLUDING BUT NOT LIMITED TO HAZARDOUS RECREATION ACTIVITIES. __________________INITIALS
TO FOREVER HOLD HARMLESS AND INDEMNIFY BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY FROM ANY AND ALL LIABILITY FOR ANY INJURY AND RO DAMAGES TO ANY THIRD PARTY RESULTING FROM MY PARTICIPATION IN ANY ACTIVITY, INCLUDING BUT NOT LIMITED TO THE HAZARDOUS RECREATIONAL ACTIVITIES. ____________________INITIALS
TO WAIVE AND RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT SHALL BE EFFECTIVE AND BINDING UPON ME, MY HEIRS, NEXT OF KIN, FAMIALY, RELATIVES, GUARDIANS, CONSERVATORS, EXCUTORS, ADMINSTRATORS, TRUSTEES AND ASSIGNS IN TH EVENT OF PROPERTY DAMAGES OR MY INJURY, DIASBILITY OR DEATH. _________________INTIALS
I HAVE READ, UNDERSTAND AND AGREE TO BE BOUND BY THE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY SPEED LIMIT, NO ALCHOLIC BEVERAGES AND OTHER RULES OF USE WHILE USING TH RECRATION AREA. I UNDERSTAND THE RULES AND AGREE THAT VIOLATION OF THE RULES MAY RESULT IN LOSS OF THE RECREATION AREA PRIVILEGES, REMOVAL FROM THE AREA AND OR SANCTIONS. ________________________INITIALS
I ACKNOWLEDGE AND UNDERSTAND THAT THE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY IS AN RIDE AT YOUR OWN RISK RECREATION FACILITY, BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NORTHER RAILROAD COOMPAMY DOES NOT SUPERVISE ATV, FOUR WHEELER, THREE WHEELER, MOTORCYCLE, DUNE BUGGY, DIRT BIKE OR BYCYCLE USE OR USERS AND ASSUMES NO RESPONSIBLILTY FOR THEM. I ACKNOWLEDGE AND UNDERSTAND THAT THIS AGREEMENT AFFORDS BURDEN CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY BROADER RIGHTS, AND PRETECTIONS THA PROVIDED STATUTE AND STATE LAW AND WILLINGLY AGREE TO SUCH BROADER RIGHTS AND PROTECTIONS FOR BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD CAMPANY. I AGREE THAT THIS AGREEMENT IS INTENDED TO BE AT LEAST AS BROAD AND INCLUSIVE AS IS PERMITTED BY LAWS OF THE STATE OF MISSISSIPPI AND THAT OF ANY PORTION IF THE AGREEMENT IS HELD INVALID, IT IS AGREED THAT THE BALANCE SHALL CONTINUE IN FULL LEGAL FORCE AND EFFECT.
I CERTIFY THAT I HAVE NO MEDICAL CONDITION THAT WOULD CAUSE PARTICIPATION OF ANY ACTIVITIES AT THE RECREATION AREA TO INCREASE THE RISK OF HAZARDS TO MY HEALTH, IN ADDITION, I AUTHORIZE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY TO PROVIDE OR CAUSE TO BE PROVIDED SUCH MEDICAL TREATMENT THAT MAY BE NECESSARY OR APPROPRATE IF I AM INJURED WHILE AT THE RECREATION AREA WITHOUT THERE BEING ANY ADMISSION OR IMPLICATION OF RESPONSIBILITY ON BUDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANDIAN NATIONAL RAILROAD COMPANY PART BY BEING SO. I UNDERSTAND AND AGREE THAT THIS AGREEMENT SHALL REMAIN IN FULL FORCE AND EFFECT AND BIND ME, MY HEIRS, ESTATE AND ASSIGNS FOR ANY AND ALL PRESENT AND FUTURE ALLOWED OR UNAUTHORIZED USE OF THE RECREATION AREA BY ME._______________INITIALS
I HAVE READ AND VOLULUANTARILY SIGNED AND INITIALED ALL PAGES OF THIS AGREEMENT, AND FURTHER AGREE THAT NO ORAL REPRESENTAIONS, OR INDUCEMENTS APART FROM THIS AGREEMENT HAVE BEEN MADE BY BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY WI REGARD TO THE SUBJECT MATTER OF THIS AGREEMENT. ____________________INITIALS
IF I AM YOUNGER THAN 18 YEARS OLD, MY PARENT (LEGAL GAURDIAN) AND I HEREBY CERTIFY THAT I AM YOUNGER THAN 18 YEARS OLD I (WE) HAVE COMPLETELY READ AND UNDERSTAND THIS AGREEMENT AND ITS TERMS, PRIOR TO SIGNING THIS AGREEMENT, I (WE) HAVE HAD THE OPPORTUNITY TO CONSULT AN ATTORNEY ABOUT THE EFFECT OF THIS AGREEMENT. I (WE) ARE AWARE THAT BY SIGNING THIS AGREEMENT I (WE) ASSUME ALL RISKS AND WAIVE AND RELEASE ALL RIGHTS THAT I (WE) AND MY HEIRS, NEXT OF KIN, FAMILY, RELATIVES, GUARDIANS, EXECUTORS, ADMINSTRATORS, TRUSTEES, AND ASSIGNS MAY HAVE AGAINST BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY. _______________________INITIALS
THIS AGREEMENT MUST BE SIGNED IN THE PRESENCE OF A BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY REPRESENATIVE
MY SIGNATURE
__________________________________________________________________________________DATE_____________________________________________
2 / 3
I, THE UNDERSIGNED, DO HEREBY CERTIFY THAT I AM THE LEGAL GUARDIAN OF THE BELOW LISTED MINOR PARTICIPANTS AND THAT I AM EXECUTING THIS WEAVER , RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT FOR AND ON BEHALF OF SAID MINOR(S) WITH ALL TERMS AND CONDITIONS OF ABOVE AND FOREGOING AGREEMENT BEING APPLICABLE TO SAID MINOR(S), THEIR HEIRS AND ASSIGNS, PARENTS GUARDIANS AS WELL AS THE MINORS LEGAL GUARDIAN
1._____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT
2._____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT
3.____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT
4.____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT
5.____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT
6._____________________________________________________________________PRINT NAME OF MONOR PARTICIPANT
X____________________________________________________________________________DATE___________________________
LEGAL GUARDIAN SIGNATURE
IF PARTICIPANT IS UNDER 18 YEARS OF AGE AND GUARDIAN IS NOT PRESENT UPON PARTICIPANT’S ENTRY TO BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY THE LEGAL GUARDIAN’S SIGNATURE MUST BE NOTARIZED IN ACCORDANCE WITH THIS WAIVER, RELEASE OF LIABILITY AND INDEMINFICATION AGREEMENT.
X____________________________________________________________________LEGAL GUARDIAN’S SIGNATURE
SUBSCRIBED AND SWORN TO BEFORE ME ON THIS THE _________________________________DAY OF________________________2018_________________
BY ________________________________________________________________________________________________________________________________
NOTARY PUBLIC IN AND FOR THE STATE OF MISSISSIPPI
MY COMMISSION EXPIRES:__________________________________________________
NOTARY’S PRINTED NAME”__________________________________________________
All riders under the age of 18 MUST have NOTARIZED Parental Consent on file.
For your convenience we have attached a printable version of our release form below. Minors must have a signed release form with them when entering the park without a parent or guardian present. ANNUAL CONVENANT NOT TO SUE, RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT LAST NAME______________________________________________FIRST_________________________________________________DOB___________________ THIS AGREEMENT APPLIES TO THE BURDENS CREEK ATV PARK CAMPING AND RECREATION AREA, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY.THIS AGREEMENT CONSTITURES AN EXPRESS CONTRACTUAL ASSUMPTION OF ALL RISKS, BOTH A WAIVER AND RELEASE OF LIABILITY FOR ANY NEGLIGENCE OR DANGEROUS CONDITION OF PRIVATE PROPERTY AND IDEMNITY FOR ALL THIRD PARTY CLAIMS [HEREINAFTER “AGREEMENT”]THE UNDERSIGNED FOR AND IN CONSIDERATION OF AND FURTHER FOR AND IN EXCHANGE OF BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD ALLOWING MY PAID USE OF THE PREMISES AS FOLLOWS:I KNOW THAT ATV, INCLUDING FOUR WHEELERS, MOTORCYCLES, THREE WHEELERS, DUNE BUGGY, DIRT BIKES, AND BICYCLE RIDING IS INHERENTALY DANGEROUS SPORTS AND RECREATION ACTIVITIES, IN WHICH I CHOOSE TO VOLUNTARILY PARTICIPATE AT MY OWN RISK. I AM AWARE THAT THE INHERENT AND USUAL GREAT RISKS, HAZARDS AND SUBSTANTIAL DANGERS OF PERSONAL INJURY, DEATH AND DISABLILTY OR PROPERTY DAMAGE AND LOSS FROM RIDING ATV’S, SUCH AS FOUR WHEELRS, THREE WHEELERS, MOTORCYCLES, DUNE BUGGY, DIRT BIKES AND BYCYCLES (COLLECTIVELY “DAMAGES”), NECESSAIRLY INCREASE WHEN I OR OTHERS USE RAMPS, TRAILS, TRACES, UNALTERED NATURAL TERRAIN, INCLINES OR DECLINES, MUD BOWLS, ROUGH EARTHERN TERRAIN AND ANY MANMADE AREA OR EARTHERN TERRAIN. I KNOW THAT THE INHERENT FORESEEN AND OFTEN UNFORESEEN RISKS, HAZARDS AND DANGERS INCLUDE, BUT ARE NOT LIMITED TO, MOTOR PROPELLED ATV’S AND BICYCLES WHICH CAN LEAD TO OR CAUSE STRAINS, BRUISES, BROKEN BONES, CONCUSSION, HEAT EXHAUSTION AND MANY OTHER INJURIES, DEATH AND PROPERTY DAMAGE RESULTING FROM FALLING OR BEING THROWN FROM THE ATV, WRECKING, JUMPING, LANDING, PREFORMING TRICKS, OR OTHER ACTIVITIES, AS WELL AS COLLIDING WITH OTHER OBJECTS, USERS, STAFF, BYSTANDERS OR SPECTATORS. I ALSO UNDERSTAND THAT THESE INHERENT, GREAT, INCREASED RISKS, HAZARDS, AND DANGERS ARE FUTHER INCREASED WHEN OTHER PERSONS, WHETHER OR NOT OF THE SOME LEVEL OF EXPERIENCE OR SKILL, ARE PRESENT AT THE SAME TIME AND USING THE SAME FACILITIES (“ALL OF THE ABOVE, DEFINED ACTIVITIES ARE COLLECTIVELY REFERRED TO THROUGHOUT THE AGREEMENT AS “THE HAZARDOUS RECREATIONAL ACTIVITIES”). BY THIS AGREEMENT, IT IS MY INTENTION TO FOREVER RELIEVE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY AND ANYONE ASSOCIATED WITH AND WORKING FOR BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY INCLUDING, BUT NOT LIMITED TO , ITS OWNERS, LANDLORDS, OFFICERS, EMPLOYEES AND AGENTS, VOLUNTEERS, SPONSORS, VENDERS, CONTRACTORS AND EXHIBITORS OR ANY DUTY TO ME AND I DO ASSUME THE ENTIRE RISK OF FORESEEN OR UN FORESEEN, KNOWN OR UNKNOWN, BODILY AND PERSONAL INJURY, DAMAGES, LOSSES, HARMS, DEATHS, PROPERTY CLAIMS, MEDICAL EXPENSES, HOSPITAL EXPENSES AND ANY OTHER TYPE OF PERSONAL OR PROPERTY DAMAGE CLAIMS OR EXPENSES THAT MIGHT OCCOR DURING THIS AGREEMENT, I ALSO INTEND TO FOREVER RELEASE, DISCHARGE AND ABSOLVE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND, AND CANADIAN NATIONAL RAILROAD COMPANY FROM ANY AND ALL LIABILIATY FOR ANY ACTIVE OR PASSIVE NEGLIGENCE WHATSOEVER BY BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND, CANADIAN NATIONAL RAILROAD COMPANY AND TO WAIVE AND RELINQUISH ANY CLAIM, DEMAND OR CAUSES OF ACTION, OF WHATSOEVER KIND OR NATURE OR KNOW OR UNKNOWN, AGAINST BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY FOR ANY PROPERTY DAMAGE, LOSS, EXPENSE AND FOR ALL PERSONAL INJURY, DAMAGE, LOSS, HARM, DEATH, HOSPITAL EXPENSE OR ANY OTHER TYPE OF EXPENSE CAUSED BY ANY NEGILGENCE OF BURDENS CREEK ATV PARK, MAPPS FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY OR OTHER PERSONS USING THE RECREATION AREA AND PROMISE NOT TO SUE OR EXERCISE ANY LEGAL RIGHT TO SEEK DAMAGES FROM BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD, BY THIS AGREEMENT, I ALSO INTEND TO AND DO FOREVER RELEASE, DISCHARGE, WAIVE AND RELINQUISH AND ABSOLVE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD FROM ANY AND ALL CLAIMS OR CAUSES OF ACTTION AGAINST BURDENS CREEK ATV PARK , MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANYFOR ANY PROPERTY DAMAGES, LOSS OR EXPENSE AND PERSONIAL INJURY, DAMAGES, LOSS, HARM, DEATH, MEDICAL EXPENSES OR HOSPITAL EXPENSES AND ANY OTHER TYPE OF EXPENSE CAUSED BY THE HAZARDOUS RECREATIONAL ACTIVITIES AND /OR BY THE CONDITION AND /OR MAINTNANCE OF THE RECREATIONAL PREMISES OR ANY OF IT EQUIPMENT, STRUCTURES OR DIVISES INCLUDING BUT NOT LIMITED TO RAMPS, TRACES, UNALTERED TERRAIN, INCLINES OR DECLINES, MUD BOWLS, ROUGH NATURAL EARTHERN TERRAIN OR ANY MANMADE RIDING AREAS OR ALTERED TERRAIN AND PROMISE NOT TO SUE OR EXERCISE ANY LEGAL RIGHT TO SEEK DAMAGES FROM BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY FOR INJURIES OR DEATH RESULTING FROM AND ACTIVITY, OR ANY REASON WHATSOEVER OR FROM ANY INJURIES OR DAMAGES WHICH OCCOR AT THE RECREATION AREA. IN CONSIDERATION OF BEING PERMITTED TO UTILIZE FOR PAY THE RECREATION AREA I AGREE AS FOLLOWS:AS TO MY PARTICIPATION IN ANY ACTIVITY, INCLUDING, BUT NOT LIMITED TO, THE HAZARDOUS RECREATIONAL ACTIVITIES AND AS SO ANY AND ALL LIABILITY AND FOR ANY INJURY OR DANAGES WHICH I MAY SUFFER OR INCUR DUE TO ANY CAUSE WHATSOEVER, WHILE ON THE RECREATION AREA PREMISES, I HEREBY AGREE: TO FOREVER WAIVE ANY AND ALL CLAIMS FOR ANY INJURY AND /OR DAMAGES THAT I MAMY HAVE AGAINST BURDENS CREEK ATE PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY OR ANY OTHER PERSON, LANDLORD, COMPANY OR ENTITY IN ANY WAY ASSOCIATED WITH IT. _________________INITALS TO FOREVER RELEASE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY FROM ANY AND ALL LOABILITY FOR ANY INJURY AND OR DAMAGES THAT I MAY SUFFER OR INCUR, OR THAT MY NEXT OF KIN MAY SUFFER, AS A RESULT OF MY PARTICIPATION IN ANY ACTIVITY, INCLUDING BUT NOT LIMITED TO HAZARDOUS RECREATION ACTIVITIES. __________________INITIALS TO FOREVER HOLD HARMLESS AND INDEMNIFY BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY FROM ANY AND ALL LIABILITY FOR ANY INJURY AND RO DAMAGES TO ANY THIRD PARTY RESULTING FROM MY PARTICIPATION IN ANY ACTIVITY, INCLUDING BUT NOT LIMITED TO THE HAZARDOUS RECREATIONAL ACTIVITIES. ____________________INITIALS TO WAIVE AND RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT SHALL BE EFFECTIVE AND BINDING UPON ME, MY HEIRS, NEXT OF KIN, FAMIALY, RELATIVES, GUARDIANS, CONSERVATORS, EXCUTORS, ADMINSTRATORS, TRUSTEES AND ASSIGNS IN TH EVENT OF PROPERTY DAMAGES OR MY INJURY, DIASBILITY OR DEATH. _________________INTIALS I HAVE READ, UNDERSTAND AND AGREE TO BE BOUND BY THE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY SPEED LIMIT, NO ALCHOLIC BEVERAGES AND OTHER RULES OF USE WHILE USING TH RECRATION AREA. I UNDERSTAND THE RULES AND AGREE THAT VIOLATION OF THE RULES MAY RESULT IN LOSS OF THE RECREATION AREA PRIVILEGES, REMOVAL FROM THE AREA AND OR SANCTIONS. ________________________INITIALS I ACKNOWLEDGE AND UNDERSTAND THAT THE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY IS AN RIDE AT YOUR OWN RISK RECREATION FACILITY, BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NORTHER RAILROAD COOMPAMY DOES NOT SUPERVISE ATV, FOUR WHEELER, THREE WHEELER, MOTORCYCLE, DUNE BUGGY, DIRT BIKE OR BYCYCLE USE OR USERS AND ASSUMES NO RESPONSIBLILTY FOR THEM. I ACKNOWLEDGE AND UNDERSTAND THAT THIS AGREEMENT AFFORDS BURDEN CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY BROADER RIGHTS, AND PRETECTIONS THA PROVIDED STATUTE AND STATE LAW AND WILLINGLY AGREE TO SUCH BROADER RIGHTS AND PROTECTIONS FOR BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD CAMPANY. I AGREE THAT THIS AGREEMENT IS INTENDED TO BE AT LEAST AS BROAD AND INCLUSIVE AS IS PERMITTED BY LAWS OF THE STATE OF MISSISSIPPI AND THAT OF ANY PORTION IF THE AGREEMENT IS HELD INVALID, IT IS AGREED THAT THE BALANCE SHALL CONTINUE IN FULL LEGAL FORCE AND EFFECT. I CERTIFY THAT I HAVE NO MEDICAL CONDITION THAT WOULD CAUSE PARTICIPATION OF ANY ACTIVITIES AT THE RECREATION AREA TO INCREASE THE RISK OF HAZARDS TO MY HEALTH, IN ADDITION, I AUTHORIZE BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY TO PROVIDE OR CAUSE TO BE PROVIDED SUCH MEDICAL TREATMENT THAT MAY BE NECESSARY OR APPROPRATE IF I AM INJURED WHILE AT THE RECREATION AREA WITHOUT THERE BEING ANY ADMISSION OR IMPLICATION OF RESPONSIBILITY ON BUDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANDIAN NATIONAL RAILROAD COMPANY PART BY BEING SO. I UNDERSTAND AND AGREE THAT THIS AGREEMENT SHALL REMAIN IN FULL FORCE AND EFFECT AND BIND ME, MY HEIRS, ESTATE AND ASSIGNS FOR ANY AND ALL PRESENT AND FUTURE ALLOWED OR UNAUTHORIZED USE OF THE RECREATION AREA BY ME._______________INITIALS I HAVE READ AND VOLULUANTARILY SIGNED AND INITIALED ALL PAGES OF THIS AGREEMENT, AND FURTHER AGREE THAT NO ORAL REPRESENTAIONS, OR INDUCEMENTS APART FROM THIS AGREEMENT HAVE BEEN MADE BY BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY WI REGARD TO THE SUBJECT MATTER OF THIS AGREEMENT. ____________________INITIALS IF I AM YOUNGER THAN 18 YEARS OLD, MY PARENT (LEGAL GAURDIAN) AND I HEREBY CERTIFY THAT I AM YOUNGER THAN 18 YEARS OLD I (WE) HAVE COMPLETELY READ AND UNDERSTAND THIS AGREEMENT AND ITS TERMS, PRIOR TO SIGNING THIS AGREEMENT, I (WE) HAVE HAD THE OPPORTUNITY TO CONSULT AN ATTORNEY ABOUT THE EFFECT OF THIS AGREEMENT. I (WE) ARE AWARE THAT BY SIGNING THIS AGREEMENT I (WE) ASSUME ALL RISKS AND WAIVE AND RELEASE ALL RIGHTS THAT I (WE) AND MY HEIRS, NEXT OF KIN, FAMILY, RELATIVES, GUARDIANS, EXECUTORS, ADMINSTRATORS, TRUSTEES, AND ASSIGNS MAY HAVE AGAINST BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY. _______________________INITIALS THIS AGREEMENT MUST BE SIGNED IN THE PRESENCE OF A BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY REPRESENATIVE MY SIGNATURE __________________________________________________________________________________DATE_____________________________________________ 2 / 3 I, THE UNDERSIGNED, DO HEREBY CERTIFY THAT I AM THE LEGAL GUARDIAN OF THE BELOW LISTED MINOR PARTICIPANTS AND THAT I AM EXECUTING THIS WEAVER , RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT FOR AND ON BEHALF OF SAID MINOR(S) WITH ALL TERMS AND CONDITIONS OF ABOVE AND FOREGOING AGREEMENT BEING APPLICABLE TO SAID MINOR(S), THEIR HEIRS AND ASSIGNS, PARENTS GUARDIANS AS WELL AS THE MINORS LEGAL GUARDIAN 1._____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT 2._____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT 3.____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT 4.____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT 5.____________________________________________________________________PRINT NAME OF MINOR PARTICIPANT 6._____________________________________________________________________PRINT NAME OF MONOR PARTICIPANT X____________________________________________________________________________DATE___________________________ LEGAL GUARDIAN SIGNATURE IF PARTICIPANT IS UNDER 18 YEARS OF AGE AND GUARDIAN IS NOT PRESENT UPON PARTICIPANT’S ENTRY TO BURDENS CREEK ATV PARK, MAPP’S FRUIT STAND AND CANADIAN NATIONAL RAILROAD COMPANY THE LEGAL GUARDIAN’S SIGNATURE MUST BE NOTARIZED IN ACCORDANCE WITH THIS WAIVER, RELEASE OF LIABILITY AND INDEMINFICATION AGREEMENT. X____________________________________________________________________LEGAL GUARDIAN’S SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME ON THIS THE _________________________________DAY OF________________________2018_________________ BY ________________________________________________________________________________________________________________________________ NOTARY PUBLIC IN AND FOR THE STATE OF MISSISSIPPI MY COMMISSION EXPIRES:__________________________________________________ NOTARY’S PRINTED NAME”__________________________________________________
