AMHS-CBC Joint Boating Waiver

Name of Participant / Athlete: *

First NameLast Name

I am interested in:*

RowingSailingBoth Rowing and SailingBoat Steering

Today's Date

Date

Best days/times I am available to row or sail:

E-mail*

Cell Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

MonthDayYear

Name of Parent / Guardian (if not 18+):

First NameLast Name

Emergency Information

Emergency Contact Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe:*

Is the athlete prescribed an inhaler?*

YesNo

Photo Release

I hereby grant permission to Azorean Maritime Heritage Society (AMHS), Community Boating Center, Inc. (CBC) or assigns (“Photographer”) the irrevocable right and unrestricted permission with respect to photographic images of the named participant at AMHS events, CBC, on boats or docks, or in which they may be included, to use and/or publish individually or in conjunction with any printed matter, in any and all media, and for any legal purpose whatsoever, including, but not limited to illustration, promotion, exhibition, publication, advertising and trade. Furthermore, I consider AMHS the sole and complete owner of any such photographs. I warrant I have the right to authorize these uses and hereby agree to hold AMHS harmless of any and all liability in perpetuity.

Informed Consent and Acknowledgement

For and in consideration of participation with Azorean Maritime Heritage Society, Inc., Community Boating Center, Inc., their affiliates, and local associations (hereafter referred to as "AMHS") and being allowed to participate in AMHS events and activities, the participant (or the parent(s) or legal guardian(s) of participant) (hereafter referred to as "participant") relinquishes any and all liability for the cause of action for personal injury, property damage or wrongful death occurring to participant arising out of participation in AMHS events, activities, the sport of rowing or sailing, and/or activities incidental thereto, whenever of however they occur and for such period said activities may continue, and by this agreement and such claims, rights, and causes of action that participant may have are hereby relinquished and the participant (or parent(s)/guardian(s)) does(do) so on behalf of my/our and participant's heirs, executors, administrators and assigns.

The participant acknowledges, understands and assumes all risks inherent in rowing/sailing and associated activities, and understands that said sports and activities involve risks to participant's person including bodily injury, partial or total disability, paralysis, and/or death, and damages which may arise therefrom and that the participant has full knowledge of said risks. These risks and dangers may be caused by the negligence of the participant or the negligence of others, including the "releasees" identified below. It is further acknowledged that there may be risks and dangers not known to us or are not reasonably foreseeable at this time.

The participant understands and assumes all risks, if any, arising from the conditions and use of the AMHS boats, facilities, and equipment at the participant's own risk. The participant agrees to abide by AMHS safety obligations and agrees not to sue, to defend, to hold harmless and to indemnify AMHS, Community Boating Center, Inc., their agents, officers and employees from any and all claims of injury or loss to person or property arising from the participant's operation or use of AMHS and Community Boating Center’s facilities, boats, and equipment.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the AMHS events and/or CBC facilities or participation in AMHS programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the AMHS and CBC, its employees, agents, members, Executive Committee (collectively and individually) and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the AMHS and CBC, its employees, agents, members, Executive Committee (collectively and individually) and representatives, whether a COVID-19 infection occurs before, during, or after being present at or participating in any AMHS program, event, or activity.

It is the purpose of this agreement to exempt, waive and relieve releasees from liability for personal injury, property damage, and wrongful death caused by negligence, including the negligence, if any, of releasees. Releasees include Azorean Maritime Heritage Society, Inc., Community Boating Center, Inc., affiliated organizations, other participants, sponsors, advertisers, owners and operators of the premises used to conduct any event and each of them, their officers, directors, agents and employees.

The participant acknowledges having read the above paragraphs and having not relied upon any representations of releasees, that they are fully advised of the potential dangers of rowing/sailing.

Medical Release and Authorization

I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the participant, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact the emergency contact in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach the emergency contact.

Permission is also granted to the Azorean Maritime Heritage Society, Inc., Community Boating Center, Inc. and its affiliates including Directors and Staff to provide the needed emergency treatment prior to the participant’s admission to the medical facility.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named participant.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature (Must be of Parent or Guardian if under 18)*

Printed Name