Release Of Liability Waiver

Check One*

CLUB MEMBERCLUB GUEST

Guest Participation Date*

Date

Your Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Emergency Contact:*

First NameLast Name

Emergency Contact Phone:*

Area CodePhone Number

Are you under 18 Years at the time of signing this waiver:*

YesNo

In consideration of being allowed to participate in any way in this sports activity, related events and activities, the undersigned appreciates and acknowledges:

1) I understant the risk of injury or illness from the activities involved in this sport is significant, including the potential for permanent paralysis and death; and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury or illness does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM ALL NEGLIGENCE OF THE RELEASEES or others and assume full responsibility for my participation; and,

2) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such hazard to the attention of the nearest official immediately; and,

3) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS PADDLESPORT RISK MANAGEMENT, LLC; CHOTA CANOE CLUB; their members; officers & directors, officials, agents,and/or employees, other participants, sponsoring agencies, commissions, sponsors, advertisers, volunteers, coaches, steerers, and, if applicable, owners and lessors of premises and equipment used to conduct club activities/ special club only events (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

4) I also acknowledge that photographs and video may be taken of me in my participation in, and attendance during this club activity, and hereby freely agree to allow without restriction all uses of such photos and videos in the reporting of club activities, special race, and/or in the promotion of such, its location, other sporting events, sport in general, and/or related purposes.

By signing below I acknowledge that I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY.

Signature*

Signed by*

First NameLast Name

Date*

Date

PARTICIPANTS OF MINOR AGE (UNDER AGE 18) - A PARENT/LEGAL GUARDIAN MUST COMPLETE AND SIGN BELOW.

This is to certify that I, as parent/legal guardian with legal responsibility for this PARTICIPANT, I have read the waiver of liability to the minor participant and confirm they fully understand its contents and therefore, I do consent and agree to his/her Waiver, Release and Indemnification, as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement in the paddling program as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

Participant Date of Birth*

MonthDayYear

Name of Parent/ Guardian*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship to Participant*

Signature of Parent/Legal Guardian*

DATE SIGNED*

RELEASE OF LIABILITY WAIVER