S4SN Event liability release waiver + media consent

S4SN Participant/ Volunteer Waiver of Release Form & Media Consent
Every person participating in or volunteering for a Surf For Special Needs hosted event MUST have a signed release on file with S4SN. This document must be filled out by the adult participant, or the minor participant's custodial parent or legal guardian.
Participant/ Volunteer Information
Participant/ Volunteer Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
MaleFemale
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
*For Minors: Parent or Guardian info. Or if participant requires an aid to travel.

First NameLast Name
Cell Phone Number
Format: (000) 000-0000.

Emergency Contact

For minors, if parent/guardian is unavailable in an emergency, notify:
Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Relationship*

Indemnify and General Release
Upon the signing of this waiver, I waive and hold harmless Surf For Special Needs (S4SN), along with its’ members, volunteers, staff, and assignee’s, and assume full responsibility for any and all injuries that may occur during my participantion including but not limited to the inherit risk of drowning and or death. Furthermore, I acknowledge that if I neglect to abide by all safety rules, regulations and instructions given by S4SN staff members and volunteers, my rights may be revoked and my participation may be terminated.

I do hereby expressly indemnify and hold harmless Surf For Special Needs from any and all claims, causes of action, or other proceedings, and from any and all liability, loss, damage, and expense of every nature, arising by reason of Surf For Special Needs enforcement of its rights and remedies hereunder. Surf For Special Needs (S4SN) shall not be liable for any error of judgment or mistake of fact or law, absent gross negligence or willful misconduct on its part.
Participant/Parent/Guardian Name*

First NameLast Name
Media Release
I hereby give my full consent to Surf For Special Needs (S4SN) to record myself/my child(ren)'s participation in any programs or events associated with S4SN. Further, I hereby transfer and assign to S4SN the exclusive rights to use and authorize others to use said images, video, and audio recordings for promotional and educational use or resource sale in the future. I understand that my/their image may be used, but my/their name or personal information will never be shared publicly without additional, separate consent.
By signing below I certify that I have read and agree to all waivers above:
Participant/ Volunteer's Date of Birth*

MonthDayYear
SelfParentGuardian
Participant/Volunteer OR Parent/Guardian Signature*

Clear
Today's Date

MonthDayYear

Should be Empty:

S4SN Participant/ Volunteer Waiver of Release Form & Media Consent

Participant/ Volunteer Information

Emergency Contact

Indemnify and General Release

Media Release