Form Center

2. Checks payable to Town of Ipswich
   Location: Bialek Park, 17 Linebrook Road, Ipswich, MA 01938
4. Player's Last Name
5. Player's First Name
7. Parent's Name(s)
9. Phone Number
11. Choose a Session

    1. 5 p.m. (Grades K - 2)
    2. 6 p.m. (Grades 3 & 4)
    3. 7 p.m. (Grades 5 & 6)
    4. 7 p.m. ( Grades 7 & 8)
13. Parent volunteers are needed to help the program run smoothly. If you are able to help, please enter your name below
15. Email Address
17. Liability Release
    RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT In consideration for being permitted to utilize the facilities, services, and programs of the Town of Ipswich for any purpose, including but not limited to observation or use of facilities or equipment, or participation in any program affiliated with the Town of Ipswich without respect to location, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the Town of Ipswich for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated programs have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use, or participation. IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE TOWN OF IPSWICH FOR ANY PURPOSE, INCLUDING BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH THE TOWN OF IPSWICH, WITHOUT RESPECT TO LOCATION, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING: THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Town of Ipswich and/or its directors, officers, employees, and agents (hereinafter referred to as “releasees”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein, or participating in any program affiliated with the Ipswich ReCreation & Culture Department without respect to location. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in, upon, or about the Town of Ipswich premises or in any way observing or using any facilities or equipment of the Town of Ipswich or participating in any program affiliated with the town of Ipswich whether caused by the negligence of the releasees or otherwise. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to negligence of releasees or otherwise while in, about, or upon the premises of the Town of Ipswich while using the premises or any facilities or equipment thereon or participating in any program affiliated with the Town of Ipswich. THE UNDERSIGNED further expressly agrees that the forgoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of Massachusetts and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Checking the box will serve as your electronic signature indicating that you have READ AND VOLUNTARILY ACCEPT THE TERMS OF THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements, or inducement apart from the foregoing written agreement have been made
19. Agreement as set forth by the Town of Ipswich

    1. I Agree
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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