Liability Release Waiver
Please complete and sign this waiver before participating in Carleton County Pickleball Club sessions without a membership.
This form is for non members participating in pickleball sessions created by Carleton County Pickleball Club.
By signing this waiver you acknowledge that the liability waiver is good for the session date and is allowable for only two sessions before expectation is that you join Pickleball Canada, Pickleball New Brunswick and become a member of the Carleton County Pickleball Club. Signing this waiver indicates that the participant is aware that they as a guest are not covered by the insurance provided to Carleton County Pickleball Club via Pickleball Canada.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Are you 18 years of age or older?
*
Yes
No
Phone Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Activity/Event Details
Confirm the details of the activity/event you are participating in.
Event Date
*
-
Month
-
Day
Year
Date
Event Location
*
Organizer / Organization Name
*
Please Select
Carelton County Pickleball Club
Emergency Contact
Who should we contact in case of an emergency?
Emergency Contact Full Name
*
First Name
Last Name
Relationship to Participant
*
Please Select
Parent
Guardian
Spouse/Partner
Sibling
Relative
Friend
Other
Emergency Contact Phone Number
*
Please enter a valid phone number.
Medical Notes / Allergies
Optional: Share relevant information that may help in an emergency.
Do you have any medical conditions, allergies, or other notes we should be aware of?
*
No
Yes
Medical notes / allergies (please describe)
Waiver Acknowledgments
Please review and confirm the statements below.
Acknowledgment of risks and assumption of risk
*
I understand that participating in the sport of pickleball involves inherent risks (including, but not limited to, injury, and other hazards), and I voluntarily assume all such risks, whether known or unknown, to the fullest extent permitted by law.
Release of liability / hold harmless and indemnification
*
I release, waive, discharge, and hold harmless the Carleton County Pickleball Club and Pickleball Canada, its officers, volunteers, agents, and affiliates from any and all claims, liabilities, demands, actions, or causes of action arising out of or related to my participation, including those caused by negligence to the fullest extent permitted by law. I also agree to indemnify and defend them from any claims arising from my acts or omissions during participation.
Rules and safety agreement
*
I agree to follow all posted rules, instructions, and safety guidelines, and I understand that failure to do so may result in removal from the activity/event without refund (if applicable).
Consent to emergency medical treatment
*
I authorize the organizer to obtain or provide emergency medical care for me if needed, and I understand I am responsible for any related costs.
Agreement Confirmation
*
I have read and understand this waiver, and I agree to be bound by its terms.
Participant Signature
Please sign below.
Participant Signature
*
Signature Date
*
-
Month
-
Day
Year
Date
Parent/Guardian Information (Minors Only)
If the participant is under 18, a parent/guardian must complete and sign this section.
Parent/Guardian Full Name
First Name
Last Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email Address
example@example.com
Parent/Guardian Relationship to Participant
Please Select
Parent
Legal Guardian
Other
Parent/Guardian Consent
I am the parent/legal guardian of the minor participant. I consent to the minor’s participation and agree to the waiver terms on behalf of myself and the minor, including the release of liability and indemnification provisions, to the fullest extent permitted by law.
Parent/Guardian Signature
Parent/Guardian Signature Date
-
Month
-
Day
Year
Date
Photo/Video Release
Yes, I grant permission for photos/videos of me to be used for promotional and informational purposes.
No, I do not grant permission.
Submit Waiver
Submit Waiver
Should be Empty: