COVENANT NOT TO SUE, RELEASE AND INDEMINITY AGREEMENT

In consideration of the acceptance of my application for this activity, I hereby covenant not to sue the organizers, the promoters, sponsors, the officials, the County of Scott, the Scott County School System or any of their employees, agents, or representatives involved with this activity and I forever waive, release and discharge, said individuals and entities and each of them from any and all claims for person injury or property damage which I may have or which may subsequently occur to me as a result of my participation in this activity and I hereby agree to indemnify and save and hold harmless said individuals and entities and each of them from any loss, liability, damage or cost they or each of them might incur due to my presence or participation in this activity.

It is expressly agreed that the forgoing not to sue, release, discharge, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by the laws of the Commonwealth of Virginia and furthermore binding on my heirs, executors and assigns.

I recognize that there may be difficulties involved with this activity and I certify that I am sufficiently physically fit to participate in such an activity and I have no physical limitations or restrictions which would prohibit my participation nor have I been advised by a physician that I have such limitations or restrictions.

IF UNDER 18 YEARS OF AGE, SIGNATURE OF PARENT OR GUARDIAN IS REQUIRED.

CHECKS PAYABLE TO SCRD - DEADLINE TO REGISTER IS MARCH 23, 2012.

The cost is $25 for 8 classes or $4 per class. Registration is open to adults & students in grades 9-12. You may mail applications to Scott County Recreation Dept.: 247 Fore Dr. Suite 201 Gate City, VA 24251 or deliver to the Rec. Dept. You may also sign up on-line at www.recreation.scottcountyva.com.

The submission of this form indicates acceptance of the terms and conditions.