2025 Liability Ins Waiver REGATTA

Paddlesport Risk Management LLC
2025 Participant Release of Liability
CHECK ONE:*

Club MemberGuest Paddler
Guest Participation Date:

MonthDayYear
Date
Participant Full Name*
Street Address*
City, State, Zip
Email*
example@example.com
Home Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Adult Paddler Signature (MINOR PADDLERS sign below)
Emergency Contact Name*
Emergency Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Today's Date*

MonthDayYear
Date
Parent/Legal Guardian Name & Address
Please Print name of Custodial Parent or Guardian
Minor's Date of Birth

MonthDayYear
Date
Parent/Legal Guardian Name & Address (PLEASE PRINT)
Emergency Contact #
Please enter a valid phone number.Format: (000) 000-0000.
Signature of Parent/Legal Guardian
Today's Date

MonthDayYear
Date
Should be Empty: