Southwest Regional Recreation Authority Permit Waiver

Prices
Annual Permit for Adults: $63
Annual Permit for SRRA Resident Adults: $33
(Discount Added in Cart)
Annual Permits for Youth: $33
(Youth Considered 17 and Under)
All 3-Day Permits: $21

First Name*

Last Name*

Display Name

Which permit are you applying for?*

Which date would you like your 3-day permit to start?*

Date

Permit Applicant Birthdate*

Date

Permit Applicant Age*

Parent or Guardian Name*

First NameLast Name

Valid Email*

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Please select county (must match your license):*

To qualify for the SRRA County Resident discount, you must live in one of these counties. County residence will be verified and providing false or misleading claims is a Class 6 felony, punishable by jail time under Virginia Code Section 12.2-10 (f).

Driver's License #*

Include Parent DL# if Permit Applicant is <18.

How did you hear about Spearhead Trails?*

Did you purchase your permit at a retail location?

Where did you purchase?

Ex: Smithville Gas-n-Go

Please read the following statements carefully. Your use of the Southwest Regional Recreation Authority facilities (hereinafter the "SRRA") is conditioned upon compliance with all user rules and Virginia Law. Your acceptance of the permit consitutes your agreement to comply with all applicable rules and laws. Violation of any rule or law renders the permit null, void and immediately revoked by the SRRA.*

COUNTY CERTIFICATION: I certify that on the date of this purchase, I live in the county stated above. I understand that my county of residence will be reviewed . I understand that criminal penalties exist for false or misleading information on SRRA Permit applications. Pursuant to Virginia Code § 18.2-498.3, any person who knowingly falsifies, conceals, misleads, or covers up a material fact, or makes any false, fictitious, or fraudulent statement or representation in a permit application submitted to the Southwest Regional Recreation Authority (SRRA) may be subject to criminal prosecution.I understand that violations of this law are classified as a Class 6 felony, carrying penalties as defined under Virginia Code Section 18.2-10 (f), including a term of imprisonment of not less than one year nor more than five years, or in the discretion of the jury or the court trying the case without a jury, confinement in jail for not more than 12 months and a fine of not more than $2,500, either or both.ACKNOWLEDGEMENT AND ACCEPTANCE OF RISK: As the applicant, I acknowledge that participation in trail activities is an inherently dangerous activity. I understand the use of the SRRA involves the danger of encountering both known and unknown hazards and risks which could result in physical or mental injury, illness or disease, damage to property, injury to third parties and death. Knowing this, I assume all risks and dangers, and I assume all responsibility for a losses and/or damages, whether caused in whole or part by any conduct of the SRRA, their agents, officers, employees, Licensors, Lessors and landowners.INDEMNIFICATION AGREEMENT: For and in the consideration of being permitted by the SRRA to use its facilities, and to participate in its recreational events and activities, I agree to this WAIVER, RELASE AND INDEMNIFICATION. I stipulate and agree to SAVE AND HOLD HARMLESS, INDEMNIFY AND FOREVER DEFEND THE SRRA, THEIR LICENSORS, LESSORS AND LANDOWNERS from and against any and all claims, actions, demands, expenses, liabilities (including reasonable attorney's fees) including negligence claims made or brought by the undersigned or by anyone on behalf of the undersigned, as a result of the undersigned's participation in SRRA's Recreational events and activities and my use of the SRRA.WAIVER AND RELEASE OF LIABILITY: By signing this form, I acknowledge that I am aware of the dangers and, that I do, on behalf of myself, my personal representatives and my heirs, voluntarily agree to RELEASE, WAIVE, DISCHARGE, HOLD HARMLESS, DEFEND AND INDEMNIFY the SRRA and their Licensors, Lessors, landowners, agents, officers and employees from any and all claims, actions, or losses or damages for bodily injury, property, wrongful death, loss of services or otherwise which may arise out of my use of the SRRA or my participation in any activities in the SRRA. I specifically understand that I am releasing, discharging and waiving any claims or actions that I may have presently or in the future for any conduct by the Licensors, Lessors, landowners, agents or employees of the SRRA. This document shall be binding on my potential heirs, executors, administrator and assigns.By submitting this application, you certify that all information provided is true, accurate, and complete to the best of your knowledge. Any attempt to provide false or misleading information may result in legal action, including criminal prosecution.RECEIPT OF POLICIES: I certify that I have received, read and reviewed SRRA Trail Rider Policies (PDF below and available at www.spearheadtrails.com).

If applicant is 18 or older, would you like to add a minor (youth under 18)?*

You must be the legal parent or guardian of any child added to the waiver.

How many children would you like to add to this waiver?*

You must be the legal parent or guardian of any child added to the waiver. Each annual permit is $33. Each three day permit is $21.

Youth permits: {youthPermit44}

Child Information*

Type a question

Youth Permit Verification (Only If Applicant is Under Age 18)*

By signing this form, as the Parent or Guardian of a participant under the age of 19, (minor) in addition to binding myself and the participant to the above terms, I am also certifying the following: 1) Any machine operated by the minor will be of a model that is recommended by the manufacturer as appropriate to the minor's age and size; 2) All rules governing the use of the SRRA have been reviewed by me and explained to the minor in sufficient detail so that the minor can abide by the same; 3) Any minor for whom I am signing who is under the age of 18 shall remain under my immediate supervision and within my sight at all times; and 4) If minor is 12 or under, I certify that my child was 12 years of age or less on the day I purchased their Youth Annual Permit. I understand that if this statement is proven false, I will be subject to a civil penalty of $100 USD, plus costs and reasonable attorne's fees required for collection and my permit will be revoked.

Type Name as Signature to Agree to Terms*

Date Signed*

Date

Signature Required Below

IsSRRAlocal

User Permit Application and Liability Waiver