Release and Indemnification Agreement

Participants engaged in programs or activities sponsored by Northern Virginia Senior Softball,
Inc., a Virginia corporation (NVSS), including but not limited to softball games, practices and/or
informal/pick-up softball related activities acknowledge that such activities are physically strenuous
and often result in physical injury. As such, participants must be physically fit to participate in such
activities and the signatory below acknowledges and assumes such risks and states that he/she is
physically fit to participate.

Participants in all NVSS programs and activities, including softball related programs, are
advised to carry their own insurance while engaging in those activities. Carrying personal medical,
liability or other insurance is particularly important because of the potential that the governmental
agencies and employees that are involved with playing field conditions will be immune from any injury
claim. It is also highly recommended that a doctor's approval be obtained prior to becoming actively
involved in such programs and activities. Having fully understood the foregoing admonitions and
acknowledging that my voluntary assumption of such risks of injury is required before any
participation is allowed, I, the undersigned, hereby apply for membership in NVSS and voluntarily
assume the risk of any injury to my person or property. I certify that I do not have any health-related
problem(s) that would prevent my participation or be a hazard to myself or any other person in the
NVSS program.

I also agree to defend, keep harmless, and wholly indemnify NVSS, its executive board,
officers, sponsors, agents and appointed personnel, as well as any State or subdivision thereof,
including Departments of Community and Recreations Services (collectively, “Indemnitees”), from
and against any and all costs, charges, losses, damages, civil or criminal actions, personal injuries or
death, arising out of or resulting from my participation in such programs or activities or any of its
social functions occurring anywhere in the world. In furtherance of such indemnification aspects of
this agreement, it is fully understood that, in the event of any suit or action brought by me, or on my
behalf, against NVSS or any of the other Indemnitees, I shall pay, on behalf of NVSS and/or any
other Indemnitees, all awards, costs, charges, attorney fees, appeal costs and damages resulting
from such suit or action.
I also fully release any and all of the Indemnitees from any and all claims that I may have in
connection with my participation in any NVSS related or sponsored activities, regardless of when,
where or how any such claim may have occurred, and I acknowledge that my right to participate in
any NVSS activity is absolutely dependent on the releases, indemnifications and acknowledgements
contained in this Agreement.

By checking this box, I am aware of and will abide by the Release and Indemnification Agreement when I submit
my membership registration to NVSS.

Signature: _____________________________________________________________________ Date: _____________________