ATHLETIC WAIVER and RELEASE OF LIABILITY

2010-2011

In consideration of being allowed to participate in any way in the THE INDUSTRIAL VAULT CLUB  (“CLUB”) Activities, Events, and/or competitions, either at the Orrville Indoor Pole Vaulting Facility, or other host location, the undersigned:

1. Acknowledge and fully understand that each participant will be engaging in activities that involved risk of injury which might result not only from their own actions, inactions or negligence, but actions, inactions or negligence of others, the rules of play or the condition of the premises or of any equipment used.  Further, that there may be other risks not known or not reasonably foreseeable at this time.

2. Assume all the foregoing risks and accept personal responsibility for damages following such injury,

permanent disability or death.

3. Release waive and covenant not to sue THE CLUB, their respective administrators, directors, coaches and other employees or volunteers of the organization, other participants, facility owners, advertisers, promoters, and related entities or individuals, all of which are hereinafter referred to as "released parties" from any and all liability to each of the undersigned, his or her heirs and next of kin for any claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the released parties or otherwise.

I, THE UNDERSIGNED, HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND

THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT

VOLUNTARILY.

__________________________      __________________________            ____________

Signature of Athlete                                        Printed Name of Athlete                            Date

____________________________     _______________________    _______   ______________     Address                                                      City                                                    State           Zip

____________________     ___________________     ________________________________

Home Phone                             Cell Phone                                E-mail Address

_________________________________          ___________________________   ______________

Signature of Parent/Guardian (if needed)               Printed Name of Parent/Guardian         Date