ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
Name of the Activity : Kayak, Paddle Boat, Canoe, Tube, Float Trip
Date and Time of Launch/Departure : __________________ Time of Return: _________________________
Vehicle COLOR/MAKE AND MODEL: _________________________________________________________________
Vehicle TAG# and State: ____________________________________________________________
Check One: Scientific Field Trip Youth/Adult Activity Volunteering
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.
I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event.
I acknowledge that this Accident Waiver and Release of Liability Form will be used by owners, employees, volunteers or representatives of Beach’n’River Rentals, the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event.
In consideration of my application and permitting me to participate in this event or activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: _____________________________________________________________________
_________________________________________________________________________________; “River Rick;” “Beachin’ Betty;” “Beach’n’River Rentals;” “Beach’n’River Vacation Home Rentals;” “Beach’n’River Canoe and Kayak Rentals” and/or their employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers;
(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise.
I acknowledge that “Beach’n’River Rentals,” “Beach’n’River Vacation Home Rentals” and “Beach’n’River Canoe and Kayak Rentals” and their owners, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of Beach’n’River Canoe and Kayak Rentals.
I acknowledge that this activity or event may involve a test of a person’s physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, wildlife, facilities, temperature, weather, condition of participants, equipment, actions of other people including, but not limited to, participants, volunteers, spectators, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to participants, but are also present for volunteers.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event.
I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose or promotional features Beach’n’River Vacation Rentals or Beach’n’River Canoe and Kayak Rentals, the event holders, producers, sponsors, organizers and assigns deem fit to include in but not inclusive to: web, print and other media.
The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
Print Participant’s Name ________________________________ Age _______ Date ____________________
(If under 19 years old, Parent or guardian must also sign)
PARENT / GUARDIAN WAIVER FOR MINORS (Under 19 years old)
The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties
referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
Print Name Of Minor Participant ________________________________
Age and Birthdate _______ _____________________________________________________
Parent or Legal Guardian Signature
_________________________________________________________ Date __________
Email address of Legal Guardian or Parent
PRINT Contact Info of Parent: Address (City/State) and Emergency Telephone Number
Driver’s License (and State of Driver’s License) of Parent: