Release Of Liability Waiver

2024 Guest Participant Release of Liability Waiver

for Hackensack River Canoe & Kayak Club activities
Guest Participation Date

MonthDayYear
Date
Guest Participant Name*

First NameLast Name
Guest Participant Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone Number

Area CodePhone Number
Home/Office Phone Number

Area CodePhone Number
Email*
example@example.com
Participant is age 18 or older.Participant is under the age of 18.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Signature required below
In consideration of being allowed to participate in any way in this sports activity, related events and activities, the undersigned acknowledges, appreciates, and agrees that: 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 THE NEGLIGENCE OF THE RELEASEES or others and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation.

If 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. I verify that I will only participate in club activities, on and off water, while in good physical and mental health and that I will not consume any mind altering drugs or alcohol prior to or during club activities that may impede my ability to participate putting myself or others at risk. I will inform the coach or team leader at the beginning of any on water activity if I am not feeling well or have a medical condition and remove myself from the activity.

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; HACKENSACK RIVER CANOE AND KAYAK CLUB; CHRIST EVANGELICAL LUTHERAN CHURCH; their 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 used to conduct club activities or
special events (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
I also acknowledge that photographs and video may be taken of me in my participation in, and attendance at this event, and hereby freely agree to allow without restriction all uses of such photos and videos in the reporting of this club activity or race, and/or in the promotion of the club, its location, other sporting events, sport in general, and/or related purposes.
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 AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Participant Signature*

Clear
Signed by*

First NameLast Name
Date*

MonthDayYear
Date
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) This is to certify that I, as parent/legal guardian with legal responsibility for this participant, do consent and agree to his/her release 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 or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. I further agree to the photographic and video release set forth above.
Parent/Legal Guardian Name

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Minor Date of Birth

MonthDayYear
Date
Parent/Legal Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Legal Guardian Signature

Clear
Signed by

First NameLast Name
Date

MonthDayYear
Date
Should be Empty:

2024 Guest Participant Release of Liability Waiver

Signature required below