Watercraft Reservation Request Form

Watercraft Reservation Request Form

Via is happy to be able to offer staff the use of kayaks and a canoe. Once we receive your submission we will review it. If the watercraft are available, we will contact you with additional details. Please provide the following information.
Name of Person Requesting Reservation*

First NameLast Name
E-mail*
example@mobilization.org
Phone Number*

Area CodePhone Number
Start Date/Time*

MonthDayYear
DateHourMinutesAM/PM Option
End Date/Time*

MonthDayYear
DateHourMinutesAM/PM Option
Who else will be using the watercraft and where will the use take place?
Please provide the names of all people in the party and where the watercraft will be used.
Watercraft(s) Requested*

Kayak 1Kayak 2Canoe
Please Read Carefully - Waiver and Release of Liability

In consideration of Via furnishing usage of the watercraft, I agee as follows:

I fully understand that outdoor recreational activities have inherent risks, dangers, and hazards. Participating in these activities may result in injury or illness.

By my participation in the usage of the watercraft, I hereby assume all risks and dangers and all responsibility for any losses and/or damages, whether caused in whole or in part by the negligence or other conduct of the owners, agents, officers, or employees of Via. I/we also agree to a properly secured USCG approved personal flotation device, of type 3 or better at all times.

I HAVE READ THE WAIVER AND RELEASE AND BY SIGNING IT, AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE CENTER FOR MISSION MOBILIZATION FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.
Digital Signature*

First NameLast Name
Today's Date*

MonthDayYear
Date
Should be Empty: