Hackground Waiver, Liability and Rules Acknowledgement Forms

FOR 2017 FLL - Hydro Dynamics Season


I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH the officers and organizers of Hackground, all employees and officers of Greenebaum Enterprises and St. Johns Properties, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by Hackground, property holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.

In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: The officers and organizers of Hackground, all employees and officers of Greenebaum Enterprises and St. Johns Properties, employees, representatives, and agents, and the activity holders, sponsors, and volunteers;

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I acknowledge that Hackground and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law

General Hackground Center Rules

Follow posted Hackground rules all the time, which include but not limited to the following

  1. No food allowed in Hackground unless provided by Team.
  2. An authorized Hackground MENTOR should be available at Hackground at all times when students are using the premises.
  3. A mentor should be notified when using tools. All tools must be put back in its original place.
  4. Power tools can be used only after notifying an authorized Hackground MENTOR.
  5. All work areas and competition field areas must be cleaned before leaving Hackground for the day.

FIRST LEGO League Policies

  1. Students have to help clean up after each meeting.
  2. Discipline: Students will maintain proper discipline while at Hackground. Refer to the Core Values section of the following web page http://www.firstlegoleague.org/about-fll . If a student receives 3 disciplinary warnings then they will have to leave the team.
  3. Attendance: A student will have to leave the team if he/she misses 2 classes without prior permission. Permission can be obtained by talking to the lead mentor.


Fee Covers

    1. Registration for one qualifier and state championship is a team participates.
    2. Team time frame: September till early to mid December for qualifiers and late February to early March for State Championship
    3. 1 Team Shirt (please enter correct shirt size when registering)
    4. Robots (2 robots per team)

Refund Policy

    1. Full refund if you cancel before September 4th, 2017
    2. 50 % if cancelled before September 11th, 2017
    3. No refund after September 11th, 2017

Please click on the link below to acknowledge that you have read and understood the waiver and the rules pertaining to your child using Hackground.

2017 FLL Hydro Dynamics Season Waiver, Liability and Rules Acknowledgement Form

For all Hackground FIRST Lego League teams


Date - August 23, 2017