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Waiver and Release Form Liability
I agree not to bring any claim, demand, and/or cause of action of any nature whatsoever against Scott
Dirck Golf Academy, or any member, officer, employee or agent for any loss, damages, and injuries
including: 1) any known and unknown, foreseen and unforeseen bodily injury, 2) loss of life, and 3) any
attorney’s fees at trial and appellate levels, and costs, expenses, or charges sustained, directly or
indirectly, or alleged to have been sustained, or in any fashion arising from, in connection with, or
resulting from the athlete’s participation in or association with the Scott Dirck Golf Academy. By
participating in the Scott Dirck Golf Academy Junior Golf Program, you acknowledge and agree that your
photo may be used in future promotional materials.
Indemnity
Further, I will indemnify and hold harmless Scott Dirck Golf Academy or any member, officer, employee
or agent from and against any claim, demand, and/or cause of action of any nature whatsoever, brought
by or on behalf of the Athlete or any member of the Athlete’s family, including, but not limited to the
Athlete’s mother, father, brother, sister, or grandparents, or any lawful blood descendants of the Athlete
for any loss, damages, and injuries including: 1) any known and unknown, foreseen and unforeseen bodily
injury, 2) loss of life, and 3) any attorney’s fees at trial and appellate levels, and costs, expenses, or
charges sustained, directly or indirectly, or alleged to have been sustained, or in any fashion arising
from, in connection with, or resulting from the athlete’s participation in or association with the Junior
Golf Programs. This agreement is binding upon my heirs, successors, or assignees. It may not be
modified orally, and a waiver of any provision shall not be construed as a modification of any other
provision herein or as consent to any subsequent waiver or modification.
I UNDERSTAND THAT THIS CONSENT CAN BE REVOKED AT ANY TIME IN WRITING EXCEPT TO THE
EXTENT Scott Dirck Golf Academy Junior Golf Program HAS RELIED ON IT.