Release Of Liability Waiver

Your role*

JUNIOR Club Member - UNDER 18 YRS OLDJUNIOR Club Member - OVER 18 YRS OLDVOLUNTEER

PARTICIPANT Name*

First NameLast Name

Date of Birth*

Date of Birth

Name of Parent/ Guardian (if signing for a minor)*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Relationship to Participant*

Eg. Parent/Legal Guardian/ self - volunteer

Pertinent Medical Information:

If there is a condition we should be aware of please indicate what

Please indicate any allergies.

In consideration for being allowed to participate in the activities with COLUMBIA GORGE JUNIOR KAYAK CLUB PARTICIPANT AGREES TO THE FOLLOWING TERMS AND CONDITIONS

1. Acknowledge and agree that water sports is an inherently dangerous activity that exposes participants to risks, both known and unknow, of harm and serious injury, including but not limited to permanent injury, sickness and death, and severe social and economic loss, which might result not only from my own action, inaction or negligence, but the action, inaction or negligence of others, wind and water conditions, or the condition of any equipment used, and that there may be other risks not known to us or not reasonably foreseeable at this time.

2. Without limitation to the foregoing, acknowledge and agree that said risks include, but are not limited to, the condition of vessels, swamping and turning over, the transport of vessels to/from the paddling location, currents, waves, winds, and distance from shore that may limit the ability of paddlers and medical/emergency personnel to timely respond to a paddling accident or personal health condition. Situations both known and unknown may arise.

3. Represents that participant can swim and/or survival float and am able to self-rescue and re-enter a without assistance in any depth of water.

4. I assume all the foregoing risks, both known and unknown, and accept personal responsibility for the harm, damages and loss following such injury, permanent disability or death.

WAIVER AND RELEASE.

PARTICIPANT, including their heirs, next of kin, assigns and estate hereby waives any and all past, present and future claims against, and releases and agrees not to sue, PADDLESPORT RISK MANAGEMENT, LLC; COLUMBIA GORGE JUNIOR KAYAK CLUB; THE MISSING CORNER; their insurers, members, directors, agents, and other participants, and any other persons or entities associated therewith (all herein referred to as “Releasees”), from all demands, claims, losses and damages on account of injury, including but not limited to death or damage to property, caused or alleged to be caused, in whole or in part, by the negligence of any of the Releasees to the extent permitted by law.

INDEMNIFICATION.

PARTICIPANT agrees to indemnify, defend and hold harmless the Releasees from and against all claims , losses, damages, causes of action, judgments, costs and expenses, including but not limited to attorneys’ fees, and all other liabilities arising out of or relating to PARTICIPANT’S participation in the paddling program and the use of the water craft and other property of RELEASEE'S even if caused by the negligence of any or all of the Releasees.

SEVERABILITY, JURISDICTION AND LAW.

This agreement is intended to be as broad and inclusive as permitted by law. If any part of this agreement is held to be invalid, the balance thereof shall remain valid and in full force and effect; and, if necessary, shall be modified to further its intent to waive rights against, and release and indemnify the Releasees, against all claims and liabilities as may be permitted by law.

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

A PARENT/LEGAL GUARDIAN MUST COMPLETE AND SIGN IF PARTICIPANT IS A MINOR.

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.

Volunteer Signature*

Signature of Parent/Legal Guardian*

Date*

DateHourMinutesAM/PM Option