Kayak and Stand Up Paddleboard Rental Agreement

Size: px
Start display at page:

Download "Kayak and Stand Up Paddleboard Rental Agreement"

Transcription

1 Welcome to Daniel Island kayak and stand up paddleboard rentals. Participants must be 18 or older to rent a water craft. Children must be a minimum of 50lbs or 3 years of age to participate. An adult must accompany children under 18 in a tandem kayak. Maximum of 1 child per adult. Each participant must wear the provided Coast Guard Approved Perscnal Floatation Device (PFD) at all times. Your signatures below indicates your understanding that the term water activity encompasses all aspects of the activity including but not limited to: getting outfitted for the activity, maintaining, repairing, loading or unloading kayaks/paddleboards or gear, and travel to and from the place of activity. Participation is entirely voluntary. Name of Participant Home Address Address Cell Phone Emergency Contact Name/Number How did you hear about us? If you are transporting our equipment on your vehicle: Vehicle make/model License Plate # Driver s License # Acknowledgement of Assumption of Risk I understand and accept that water activities expose me to numerous known and unanticipated risks that could result in personal injury, illness, death or damage to me or my property. Some of the risks or factors include but are not lir.1ited to the following: The hazards of traveling in any water craft in rough water conditions Water hazards including trees and other obstacles, wind, currents and power boats First aid or emergency treatment that may be rendered Accidents or illness in remote places without medical facilities Becoming lost or disoriented Hiking or walking in rugged terrain including wet and slippery conditions Injuries inflicted by animals, insects, reptiles or plant The force of nature including wind driven projectiles, lightning and other weather My physical condition, the physical exertion associated with paddling and swimming in conditions of strong currents, wind and waves Carrying, loading and unloading of watercraft and other equipment

2 I agree to accept and assume all responsibility for personal injury, illness, death or damage to myself, my property or rented property arising from participation in this water activity. I choose to participate with full awareness of the risks, named and unnamed. That being said, my participation is completely voluntary. I agree to obey the rules and regulations that Daniel Island Property Owners Association has set out to ensure my safety. I agree to wear a PFD (Personal Floatation Device) at all times while participating in the water activities through Daniel Island Property Owners Association (POA). I have carefully read and understand the Acknowledgement and Assumption of Risk. I understand that if, after reading this document, I choose not to participate in the water activities, I will not be charged for participation and if I have been charged, I will receive a full refund. Participants that understand and accept full responsibility for injured persons of property please initial: Additional Fees If any rented equipment is damaged, lost, or stolen, the renter will be charged full replacement or repair costs at retail prices. Daniel Island POA reserves the right to charge an additional Yz day or full day fee for each water craft that is returned later than their expected return time. Please initial to indicate your full compliance and understanding of these terms: Release of Liability and Indemnification Agreement In consideration of Daniel Island POA s services that enable me to participate in this activity, I release and forever discharge Daniel Island POA, DICA, DIPA, and DITA and its officers, agents, employees and volunteers from any and all liability or claims for any injury, illness, death or damage to myself or my property that results out of or in any way is linked with my participation in this activity. This release and discharge specifically includes, but is not limited to liability or claims based upon negligent acts or omissions of Daniel Island POA. I hold Daniel Island POA, DICA, DIPA, and DITA harmless from all liability, actions, causes of actions, debt claims and demands of every kind of nature whatsoever which I now have or which may arise from or in connection with my participation in this activity. I further promise and agree not to sue, assert or otherwise maintain a claim against Daniel Island POA, DICA, DIPA, and DITA or its officers, agents or employees, for any injury, illness, death or damages I may sustain to myself or my property arising from or in any way are linked with this activity. Should it be necessary that an attorney be needed for Daniel Island POA or someone on Daniel Island POA s behalf, I agree to pay Daniel Island POA s reasonable costs and attorney s fees thereby expended, or for which liability is incurred.

3 Release of Liability and Indemnification Agreement (cont.) If any bodily injury or damage should occur to myself or property damage to a third party, I certify that I have sufficient health, accident, and liability insurance. If I have no such insurance, I verify that I am capable of personally paying for any and all such expenses or liability. I agree to release Daniel Island POA, DICA, DIPA, and DITA, its officers, agents, employees and volunteers for any claim, including attorney fees, costs and liability for any actions brought by or on behalf of my child or minor in my care. My signature and date below indicates that I have read and understand the detailed document in its entirety. I understand it completely and I understand that it affects my legal rights and agree to be bound by its terms. Signature of Participant Date Print Name If the participant is under the age of 18, Parent/Guardian please sign below: Signature of Parent/Guardian Date Print Name Office Use Only Equipment Rented Time Out Time In Key/Locker # Kayak/SUP # Rental Fee Damage Fee

4 Participant Release Of Liability and Assumption of Risk Agreement * * * Read Before Signing * * * Participant Name In consideration of being allowed to participate in any way in the program, related events and activities (hereafter called the Program), I the undersigned, acknowledge, appreciate, and agree that: I. The risk of injury from the activities involved in this program is significant during all phases of the activity, including the potential for permanent paralysis, disability and death. These risks include but are not limited to: Equipment failure and/or malfonction of my own or other s equipment; my own negligence and/or the negligence of others; Attack or encounter with insects, reptiles ; and/or animals; Fatigue, chill and/or dizziness which may diminish my/our reaction time and increase the risk of accident; Outdoor activitic; include but are not limited to risks of exposure to elements, excessive heat, hypothennia. impact of the body upon the water, injection of water into my body orifices, exposure to animals with the risk of them kicking, biting, shying away, running off or othenwise moving in an unanticipnted manner causing injury and/or death. I agree to wear any necessary safety equipment provided to me and recognize that failure to do so increases the potential for severe injury or denth and absolves the RELEASEES from any liability whatsoever. 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation in the Program. 3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official inune- liately. 4. I recognize that it may be necessaiy for the (Releasees) to refuse or tenninate my participation ifl am judged to be incapable of meeting the rigors or requirements of the Program. I accept the (Releasees) right to take such actions for the safety of myselt and/or other participants. I will not engage in any activity beyond my capabilities and will not cauo;e any third pnrty to be endangered by 1L,y or my actions during the program. I warrant and represent that I am in good health and have no physical or mental limitations or problems that would affect my safe participation or the safety of others in the program and have not been advised otherwise by a qualified medical person.

5 Participant Release Of Liability and Assumption of Risk Agreement * * * Read Before Signing * * * 5. By participating in or attending any activity in connection with this program, whether on or off the premises, I consent to 1 he us,: of any photographs, pictures, film or videotape taken of me or provided by me for publicity, promotion, television, websites or any other use, and expres.c;ly waive any right of privacy, compensation, copyright or other ownership right connected to same. 6. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE DANIEL ISLAND COMMUNITY ASSOCIATION. INC., its officers, officials, agents and/or employees, other participants, sponsors, advertisers, ancl, if applicable, owners and lessors of premises used to conduct thee vent (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF nm RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABil,ITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUTANY INDUCEMENT. Signature of Participant Date FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin. l release and agree to indemnify and hold harmless the Relcasees from any and all liability incidents to my minor child s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent pennitted by law. Parent/Guardian Signature Date Emergency Phone Number(s)

(Student Last name, First name Middle Initial).

(Student Last name, First name Middle Initial). 2013-14 (Student Last name, First name Middle Initial). Consent for Field Trip (P1a) DHS Band Combined Form P1a, P1b, P1c I hereby consent for the above named student to participate in athletic team, band,

More information

Nights of Lights Youth Opti Regatta. ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, Skipper s Name: DOB: Age: Boat/Fleet:

Nights of Lights Youth Opti Regatta. ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, Skipper s Name: DOB: Age: Boat/Fleet: Nights of Lights Youth Opti Regatta ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, 2018 Skipper s Name: DOB: Age: Boat/Fleet: Club: Sail Number: Coach Name: Coach Phone: MUST CHECK

More information

OHIO STATE UNIVERSITY EXTENSION

OHIO STATE UNIVERSITY EXTENSION OHIO STATE UNIVERSITY EXTENSION SUMMER 4-H CAMP WHERE DREAMS COME TRUE Registration Form June 3-7, 2019 Office Use Only Payment: Cabin: Team: Camper Name_ Home Address Gender Date of Birth Grade in School

More information

ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE

ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE DATE: JUNE 22 & 23, 2019 OCTOBER 5 & 6, 2019 LOCATION: THE MARKET COMMONS TIME: JUNE SATURDAY 11 AM 8 PM / SUNDAY 11 PM 7

More information

University of Maryland-Campus Recreation Services MAP Trip Registration Packet

University of Maryland-Campus Recreation Services MAP Trip Registration Packet University of Maryland-Campus Recreation Services MAP Trip Registration Packet Trip Name: Trip Please read the following trip information carefully. Please initial and sign where requested to acknowledge

More information

CITY KIDS DAY CAMP REGISTRATION FORM

CITY KIDS DAY CAMP REGISTRATION FORM RETURN CAMP ENTRY FORM WITH PAYMENT TO: M.C. PARKS 100 E. MICHIGAN BLVD. SUITE 2 MICHIGAN CITY, IN 46360 (219) 873-1506 www.michigancityparks.com CITY KIDS DAY CAMP REGISTRATION FORM 1. HOUSEHOLD INFORMATION

More information

Get!a!Grip:!Fall!2018! Information*and*Form*Package*

Get!a!Grip:!Fall!2018! Information*and*Form*Package* GetaGrip:Fall2018 Information*and*Form*Package* Pleasereturnthefollowingdocumentscompletedto: 1.Email:info@elevationoutdoors.ca OR 2.Mail:P.O.Box20071,TowneCentre,Kelowna,BC,V1Y9H2 ElevationOutdoorsWaiver

More information

Participant Name: Preferred Name: Male: Female: Home Address: City: State: Zip: Emergency Phone: Cellular Phone:

Participant Name: Preferred Name: Male: Female: Home Address: City: State: Zip: Emergency Phone: Cellular Phone: GLOBAL BOARDING: HALF DAY WATER SPORTS (MORNING) 2019 APPLICATION Mail to: PO Box 1192, Wainscott, New York 11975 Or Email/Fax: (with credit card/check information) to: info@globalboarding.com or Fax:

More information

Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado (970) LLAMA LEASE AGREEMENT

Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado (970) LLAMA LEASE AGREEMENT Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado 81344 (970) 560-2926 No. LLAMA LEASE AGREEMENT Redwood Llama Company, LLC ( Lessor ) agrees to lease to the Customer named below

More information

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree:

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree: WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS As consideration for being allowed to participate in the event described below, I agree: 1. I acknowledge that motor vehicle activity is a potentially

More information

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR Please print clearly. Completion of the registration process is required for each participant prior to program start

More information

Telluride Ski and Golf Assumption of Risk, Release of Liability, and Indemnity Agreement 3. Media Release: 4. Medical Care: 5.

Telluride Ski and Golf Assumption of Risk, Release of Liability, and Indemnity Agreement 3. Media Release: 4. Medical Care: 5. Telluride Ski and Golf Assumption of Risk, Release of Liability, and Indemnity Agreement The purpose of this Agreement is to exempt, waive, and release Released Parties from any and all liability for wrongful

More information

CULINARY CAMP. Contact and Medical Information. Parent/Guardian s name: Work Phone: Home Phone: Cell Phone:

CULINARY CAMP. Contact and Medical Information. Parent/Guardian s name: Work Phone: Home Phone: Cell Phone: CULINARY CAMP Contact and Medical Information Child s name: Parent/Guardian s name: Work Phone: Home Phone: Cell Phone: Email: In case of an emergency, when neither parent/guardian can be reached, please

More information

NSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m.

NSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m. PREVIEW DAY NSU Multimedia Camp Wednesday, March 28, 2018 8:00 a.m. 6:00 p.m. Parent/Guardian Contact Information Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement Photo Release

More information

MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM

MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM Camp Information Address: City, State, Zip Code: Gender: Medical Information The decision whether to permit the participant identified

More information

Welcome Team Advisors and Coaches;

Welcome Team Advisors and Coaches; Welcome Team Advisors and Coaches; We the Directors of the Texas High School Bass Association want to welcome you to the THSBA! Many of you have watched the growth of our organization over the last four

More information

Release of Liability PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM USROWING.

Release of Liability PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM USROWING. Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy

More information

PARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

PARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT EXHIBIT D PLEASE READ CAREFULLY (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I,, a person being over the age of eighteen, hereby enter this RELEASE

More information

2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education

2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education 2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education Welcome to NSU Youth Academy! We are excited to have your child with us. In order to provide the best experience for our students

More information

SKIPPER MARINE OF MADISON, INC.

SKIPPER MARINE OF MADISON, INC. SKIPPER MARINE OF MADISON, INC. Reservation/Rental Date: 5381 Westport Road Boat/Rental Type: Madison, WI 53704 608-246-2628 Customer Name: Driver s License #: State: Date of Birth: / / Phone 1: Phone

More information

*** ALL handlers/riders/drivers MUST complete this form *** CONDITIONS OF ENTRY AHSA LIABILITY DECLARATION EVERY HANDLER, RIDER, DRIVER, GROOM & ANYONE HANDLING A HORSE OR PONY MUST COMPLETE THE ARABIAN

More information

VICTORIA CITY ROWING CLUB, a British Columbia society, having its address at 5100 Patricia Bay Highway, Victoria, British Columbia V8Y 2T6

VICTORIA CITY ROWING CLUB, a British Columbia society, having its address at 5100 Patricia Bay Highway, Victoria, British Columbia V8Y 2T6 This Agreement made [Date ] BETWEEN: VICTORIA CITY ROWING CLUB, a British Columbia society, having its address at 5100 Patricia Bay Highway, Victoria, British Columbia V8Y 2T6 ( VCRC AND: Full name and

More information

Lake Washington Rowing Club

Lake Washington Rowing Club Lake Washington Rowing Club 2018 Junior Rowing Program Participant Information Form Participant Information (all fields must be filled out),, Last Name First Name Today s Date Mailing Address Birthdate

More information

Dear Team Captains, Managers and Members The waiver consists of : 1. Team Waiver which also acts as the team roster. 2. Combined Team waiver signature page for: Apendix A, B, B1, C 3. Appendix A: Team:

More information

The Allegheny River Rumble

The Allegheny River Rumble Three Rivers Adaptive Sports & Golden Triangle Water Ski Club Presents: The Allegheny River Rumble Sunday August 26, 2018 Golden Triangle Water Ski Club facility on the Allegheny River s Nine Mile Island

More information

REQUEST FOR AUTHORIZATION STUDENT TRAVEL: UNIVERSITY ORGANIZED OR SPONSORED EVENTS THE UNIVERSITY OF TEXAS AT AUSTIN. Requestor/Sponsor Information

REQUEST FOR AUTHORIZATION STUDENT TRAVEL: UNIVERSITY ORGANIZED OR SPONSORED EVENTS THE UNIVERSITY OF TEXAS AT AUSTIN. Requestor/Sponsor Information Part I. Requestor/Sponsor Information Name of University Employee Responsible for Trip: Position /Title: Administrative Unit/Organization: Phones: Office Cell Email Part II. Trip Information Purpose of

More information

RELEASE, AGREEMENT NOT TO SUE AND INDEMNIFICATION

RELEASE, AGREEMENT NOT TO SUE AND INDEMNIFICATION Ride Idaho 2017 GENERAL RELEASE AND ASSUMPTION OF RISK: This is a General Release of all claims, an Agreement Not to Sue, an Assumption of Risk, and an Indemnification Agreement (Release) in favor of Ride

More information

Name - Mailing Address - Address - Occupation - Home Phone - Work Phone - Date of Birth - \ \ Name - Home Phone - Work Phone -

Name - Mailing Address -  Address - Occupation - Home Phone - Work Phone - Date of Birth - \ \ Name - Home Phone - Work Phone - Please take time to carefully fill out this form as it will help us to plan your trip to your satisfaction. Name - Mailing Address - Email Address - Occupation - Home Phone - Work Phone - Date of Birth

More information

Keg Creek Watersports 3780 Dogwood Ln Appling, Ga (706) Waiver, Release of Liability and Assumption of Risk Agreement (EXHIBIT A )

Keg Creek Watersports 3780 Dogwood Ln Appling, Ga (706) Waiver, Release of Liability and Assumption of Risk Agreement (EXHIBIT A ) Keg Creek Watersports 3780 Dogwood Ln Appling, Ga 30802 (706) 339-0386 Waiver, Release of Liability and Assumption of Risk Agreement (EXHIBIT A ) I. DISCLAIMER: YOU MUST BE AT LEAST 18 YEARS OF AGE TO

More information

Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form

Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Fall Athletics, 2018 The Parent(s)/Guardian(s) must fill in all blanks. Please print clearly. Athlete s Name: Date of

More information

Schedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete

Schedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete When: Saturday, December 9. 2017 Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete Instructors: SU Coaches & current SU Athletes Schedule: 9:00-9:45 Registration 9:45

More information

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer:

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer: Registration Form Gymnast/Dancer Information Name: Date of Birth (MM/DD/YYYY): School (For Scheduling Purposes): School District (For Scheduling Purposes): Special Information (allergies, medical, behavioral,

More information

UNITED STATES AUTO CLUB

UNITED STATES AUTO CLUB UNITED STATES AUTO CLUB 2015.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK

More information

The 2018 Rhode Island NFAA Sanctioned 300 Round NFAA State Championship

The 2018 Rhode Island NFAA Sanctioned 300 Round NFAA State Championship The Rhode Island Field Archery Association is proud to present : The 2018 Rhode Island NFAA Sanctioned 300 Round NFAA State Championship Hosted By: Tangy s Archery --Youth Form-- Style Division Target

More information

TITAN SOFTBALL CAMPS Registration Form

TITAN SOFTBALL CAMPS Registration Form Registration Form CAMP DATE: CAMPER S NAME: CONTACT INFORMATION ADDRESS: CONTACT EMAIL: CONTACT PHONE: PLAYER INFORMATION AGE: GRAD YEAR (HS): PRIMARY POSITION (circle ONE choice): P C 1B 2B 3B SS OF UTL

More information

ATTACH CURRENT PHOTO OF CHILD

ATTACH CURRENT PHOTO OF CHILD Administrative Use Only Date Received Initials Date Entered Initials Acceptance Letter Initials ATTACH CURRENT PHOTO OF CHILD EXPLORERS CADETS BOXING VENTURING BASKETBALL EXPLORER ACADEMY SPRING DAY CAMP

More information

ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT Participant s Name: Age: Date of Birth : (M) (D) (Y) Address: City: Province:

More information

NON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

NON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT NON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT Albright allows Participants to participate in Participant activities that may involve or require overnight

More information

CAMP/CLINIC DATES: July 21 22, 2018 and/or August 11 12, 2018 MEDICAL HISTORY. Street City State Zip

CAMP/CLINIC DATES: July 21 22, 2018 and/or August 11 12, 2018 MEDICAL HISTORY. Street City State Zip Please fill out this form completely. It is important for the provision of proper medical care. The section marked Physician s Comments need only be completed if the participant has a major health problem.

More information

TULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / /

TULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / / Physical Examination Information Date / / Name of Camp: Name of Participant: Age: Birth date: / / Each participant must EITHER attach a copy of a physician conducted sports examination applicable to this

More information

AMERICAN YOUTH FOOTBALL Volunteer Forms

AMERICAN YOUTH FOOTBALL Volunteer Forms Volunteer Forms REQUIRED FOR REGIONAL AND NATIONAL PARTICIPATION Volunteer forms must be presented for compliance verification prior to any team participation in any American Youth Football, Inc., American

More information

Kaiser Permanente Corporate Run/Walk Boot Camp Information

Kaiser Permanente Corporate Run/Walk Boot Camp Information Kaiser Permanente Corporate Run/Walk Boot Camp Information Lead by: Celebrity Fitness Trainer, Tammie Leady 2017 Boot Camp Dates: July 22, 29, August 5, 12, 19, 26 (in the event of rain, boot camp will

More information

FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics.

FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics. FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics. Name/: Date & Day of Event: Start Time: End Time: *see page 2 for set times available

More information

Name: Name: Street: Street: City: State: Zip: City: State: Zip: Date of Birth: Date of Birth:

Name: Name: Street: Street: City: State: Zip: City: State: Zip:     Date of Birth: Date of Birth: PLAYER WAIVER PLAYER WAIVER Name: Street: City: State: Zip: Email: Date of Birth: We want all our patrons to have fun and stay safe. Following a few simple rules and the instructions of Red Zone Adventures

More information

Individual Waiver. PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY

Individual Waiver. PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY PUEBLO RANGERS Individual Waiver Soccer Club PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY (MUST BE COMPLETED AND PRESENTED AT LEAST 30 MINUTES PRIOR TO YOUR FIRST

More information

LIMITATION OF LIABILITY

LIMITATION OF LIABILITY The Swiss Alps Natural Balance Retreat ( the Retreat ) (including Limitations of Liability, Release and Waiver of Liability, Hold Harmless, Covenant Not to Sue, Assumption of Risk and June 19-26 th, 2016

More information

Information about membership -

Information about membership - MEMBERSHIP INFORMATION 2018 We are excited about ST. CROIX JOAD and the opportunities that will present themselves to youth archers ages 8-20. ST. CROIX JOAD is one of only a handful USA ARCHERY JOAD clubs

More information

UNITED STATES AUTO CLUB

UNITED STATES AUTO CLUB UNITED STATES AUTO CLUB 2016.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK

More information

TRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL

TRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL TRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL Program Name: Destination: Name(s) of LSC Employee Traveling with Group: LSC Employee(s) phone contact: - - or - - Budget

More information

SKATEBOARD COMPETITION ENTRY FORM

SKATEBOARD COMPETITION ENTRY FORM CITY OF KISSIMMEE PARKS, RECREATION & PUBLIC FACILITIES SKATEBOARD COMPETITION ENTRY FORM For your convenience, competition entry forms will be accepted in person, by mail, via fax or email at the location

More information

Instructions for Completing Ford DSFL Waivers

Instructions for Completing Ford DSFL Waivers Instructions for Completing Ford DSFL Waivers 1) Print out the four (4) forms attached. (Print in color if possible) 2) All 4 forms must be filled in COMPLETELY. If forms are not completed and signed properly

More information

University of Washington UWild Adventures Rental Agreement Acknowledgement of Risk & Waiver of Liability. Last: First: Items listed above are due

University of Washington UWild Adventures Rental Agreement Acknowledgement of Risk & Waiver of Liability. Last: First: Items listed above are due Last: First: Item Number Item Description Fines (Staff Use Only) Items listed above are due Date Day Time *Rental items are due by the end of regular business hours on the date noted above DEPOSIT (Must

More information

The 2017 Rhode Island NFAA Sanctioned 300 Round NFAA State Championship

The 2017 Rhode Island NFAA Sanctioned 300 Round NFAA State Championship The Rhode Island Field Archery Association is proud to present : The 2017 Rhode Island NFAA Sanctioned 300 Round NFAA State Championship Hosted By: Trader Jan s --Youth Form-- Style Division Target Choice

More information

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet D.M.G. Athletics Presents The Official Indoor/Outdoor Summer Basketball League Team Registration Packet Questions: Contact Coach Dawne Gittens at 860-929-7692 or via email at dgittens@bgchartford.org Team

More information

Personal Medical Record

Personal Medical Record Personal Medical Record Personal details Age: Height (in meters): Weight (in kgs): BMI (kgs/metres 2 ): *Online BMI calculation tools are easily available 1. Any previous illness - past 3 months (mention

More information

South Suburban Youth Rugby Club

South Suburban Youth Rugby Club South Suburban Youth Rugby Club Middle School Grades 4-8 High School Fresh-Soph & Varsity Registration for 2016 Spring Season ALL FORMS MUST BE COMPLETED AND TURNED IN AND DUES PAID IN FULL BEFORE A PLAYER

More information

CHINESE CULTURE CAMP REGISTRATION FORM

CHINESE CULTURE CAMP REGISTRATION FORM CHINESE CULTURE CAMP REGISTRATION FORM Child s Information: Last Name: First Name: MI: Nickname: Gender: M F Birth Date: Age: Primary Phone #: School Attending: Grade: Parent(s)/Guardian(s) Information:

More information

Release and Waiver of Liability. Release and Waiver of Liability for Adults Page 2 & 3. Release and Waiver of Liability for Minor Page 4 & 5

Release and Waiver of Liability. Release and Waiver of Liability for Adults Page 2 & 3. Release and Waiver of Liability for Minor Page 4 & 5 Release and Waiver of Liability Release and Waiver of Liability for Adults Page 2 & 3 Release and Waiver of Liability for Minor Page 4 & 5 1 Release and Waiver of Liability for Adults Adult - An adult

More information

2017/18 Out of School Program Registration Form

2017/18 Out of School Program Registration Form 2017/18 Out of School Program Registration Form Child: First Name MI Last Name YMCA Member Non Member E-mail NOTE: There is a one time, non-refundable $20 registration fee per child required to secure

More information

UGA Livestock Judging Camp Athens, Georgia June 26-28, Participant Name: Parent/Guardian: Phone: Address: City: State: Zip: School:

UGA Livestock Judging Camp Athens, Georgia June 26-28, Participant Name: Parent/Guardian: Phone: Address: City: State: Zip: School: PLEASE PRINT UGA Livestock Judging Camp Athens, Georgia June 26-28, 2018 Participant Name: Parent/Guardian: Phone: Address: City: State: Zip: School: Email: Grade: Shirt Size: YS YM YL YXL AS AM AL AXL

More information

Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church

Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church th Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church Session II: June 12th - June 16th, Performance June 13th; Music On Wheels Academy Music Camp

More information

MAKE WELLSTON BEAUTIFUL, INC

MAKE WELLSTON BEAUTIFUL, INC MAKE WELLSTON BEAUTIFUL, INC Parks and Recreation Programs REGISTRATION FORM Please submit this form along with your completed Emergency/Release Form and Registration Fee. Make checks payable to Make Wellston

More information

ADULT COACHING APPLICATION

ADULT COACHING APPLICATION - MIAMI ROWING & WATERSPORTS CENTER, Inc. ADULT COACHING APPLICATION -MEMBER HRLY Private lessons where non-members and members can come and row in a one-on-one session tailored to your skill level and

More information

SUMMER CAMP ACKNOWLEDGEMENT OF RISK FORM

SUMMER CAMP ACKNOWLEDGEMENT OF RISK FORM SUMMER CAMP ACKNOWLEDGEMENT OF RISK FORM I,, am the parent and/or legal guardian of, a minor child under the age of 18 years. I would like to have my child participate in the following CAMP/PROGRAM at

More information

Deerfield Beach Surf Camp 2018 Registration Form

Deerfield Beach Surf Camp 2018 Registration Form Deerfield Beach Surf Camp 2018 Registration Form For camp information call 954-281-2797 or go to www.islandcamps.com Camper s name DOB Parent/Guardian Name Address City State Zip Email: Phone (C) Phone

More information

Please fill out both sides of this form!!!

Please fill out both sides of this form!!! $ # Circle one: Mixed Doubles Rockbridge Hunt Hunter Pace & Trail Ride Please fill out both sides of this form!!! Entry fee: Adult rider (18 and over) -- $35 per horse Junior rider (under 18) -- $20 per

More information

Form Generic Liability Waiver. Legal Disclaimer

Form Generic Liability Waiver. Legal Disclaimer Form Generic Liability Waiver Developed by Ashley Newhall * and Kathleen Tabor Legal Disclaimer Attached is a generic liability waiver. This waiver is for educational purposes only! Using this form does

More information

Before and After School Care

Before and After School Care Before and After School Care BLAIR FAMILY YMCA 2016-2017 School Year Registration Forms To put Christian principles into practice through programs that build a health spirit, mind and body for all. -YMCA

More information

SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM

SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM Personal Information Child s Name Age of Birth Parent/Legal Guardian 1 Phone Parent/Legal Guardian 2 Phone Address Alternate Phone work cell other

More information

WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely

WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely 1. Name: First Last M.I. 2. Email: 2. Mailing Address:

More information

Personal Finance Summer Institute Application Instructions: Read all instructions carefully, incomplete applications will not be considered.

Personal Finance Summer Institute Application Instructions: Read all instructions carefully, incomplete applications will not be considered. Application Instructions: Read all instructions carefully, incomplete applications will not be considered. The 2017 will be June 26 June 30. Complete all fields in the Summer Institute Application. Print

More information

RENTAL SAFETY CHECKLIST

RENTAL SAFETY CHECKLIST RENTER NAME: Individuals renting a pleasure craft fitted with a motor are required to complete a Safety Check List. PLEASE INITIAL EACH BOX ON THE FORM AS THE SUBJECT IS COVERED BY THE RENTAL OPERATOR/

More information

Blue Chip BOTT Event Agreement and Waiver

Blue Chip BOTT Event Agreement and Waiver Blue Chip BOTT Event Agreement and Waiver BLUE CHIP AGREEMENT AND LIABILITY WAIVER (this "Agreement and Waiver") PLEASE READ THE FOLLOWING AGREEMENT CAREFULLY, AS IT AFFECTS YOUR FUTURE LEGAL RIGHTS. BY

More information

APPLICATION FOR PART TIME EMPLOYMENT

APPLICATION FOR PART TIME EMPLOYMENT APPLICATION FOR PART TIME EMPLOYMENT Position: Desired Hourly Rate: Last Name First Name Date Address Street City State Zip Code Phone Number Email Address Are you at least 18 years of age or older? Yes

More information

Upper Natoma Rowing Club Junior Member Application (Please print clearly)

Upper Natoma Rowing Club Junior Member Application (Please print clearly) Upper Natoma Rowing Club Junior Member Application (Please print clearly) Name Birth Date Address City State Zip Code Phone Numbers (Home) Athlete (Cell) Athlete E-mail address School Graduation Year USRA

More information

RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS

RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activity: CSU, Chico Recreational Sports Youth Camps Activity Date(s) and Time(s): Summer 2018 (June 11 August 10,

More information

Watercraft and Equipment Rental Contract

Watercraft and Equipment Rental Contract Watercraft and Equipment Rental Contract (662) 578-7922 30117 Blackjack Road Sardis, MS 38666 rentals@sardismarina.com www.sardismarina.com Renter/Lessee Full Name: Date: Address: _ City: State: Zip Code:

More information

WEB: eaglelakecamps.com. PHONE: 800-US-EAGLE ( ) (local) FAX:

WEB: eaglelakecamps.com. PHONE: 800-US-EAGLE ( ) (local) FAX: WEB: eaglelakecamps.com PHONE: 800-US-EAGLE (873-2453) 719-272-7453 (local) FAX: 719-960-2558 MAIL: Eagle Lake Office P.O. Box 6819 Colorado Springs, CO 80934 RELEASE OF LIABILITY AND CONSENT TO MEDICAL

More information

Dance Competition Rules and Regulations

Dance Competition Rules and Regulations Dance Competition 2017-2018 Rules and Regulations Hmong Cultural New Year Celebration, Inc. Competition 2017-2018 will be held on December 27 through December 29. HCNYC Policy: all contestants pay the

More information

Yoga Retreat Terms and Conditions

Yoga Retreat Terms and Conditions SUNDARA DESTINATIONS, LLC Yoga Retreat Terms and Conditions Sundara Destinations, LLC ( Sundara ) is committed to providing the highest quality yoga experience for all of our guests. To help make that

More information

Medical Release Form/Media Release Form

Medical Release Form/Media Release Form Medical Release Form/Media Release Form All participants in TCS events must have a signed Waiver & Release Form, including adults 19 years and older. Participants under 19 must have the authorized signature

More information

Fall 2018 Wellness Series

Fall 2018 Wellness Series Fall 2018 Wellness Series The National MS Society offers Wellness programs in the New Jersey Metro area. These programs are for people with MS, and classes are adapted for different abilities. Caregivers/Partners

More information

*AHSEP reserves the right, at its sole discretion, to reject any candidate who does not meet the eligibility requirements as stated herein.

*AHSEP reserves the right, at its sole discretion, to reject any candidate who does not meet the eligibility requirements as stated herein. AHSEP Enrollment Information Hobie Wave 14 Sailing Classes Youth: Thursdays July 27 & August 3 5:30 8:30 Adults: Saturdays July 29 & August 12 1:30-4:30 The 2017 Hobie Wave 14 Sailing Classes will be a

More information

SHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2018 EcoRangers Application, Health Form/Consent, and Liability Waiver

SHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2018 EcoRangers Application, Health Form/Consent, and Liability Waiver SHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2018 EcoRangers Application, Health Form/Consent, and Liability Waiver CAMP SESSIONS AND COSTS LISTED ON PAGE 2 APPLICATION DUE DATE: JUNE 22, 2018 Application

More information

Grand Island Central Catholic Shooting Team

Grand Island Central Catholic Shooting Team Letter Program Requirements Signed Parental Consent Form. Signed Code of Conduct Form (Student & Parent / Guardian). Be enrolled At GICC during the time of participation. Follow & Live The "Code of Conduct".

More information

Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver

Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver Camp Sessions Listed on Page 2 Application Due June 22, 2018 Application must be complete in

More information

Promoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF.

Promoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF. Dear Race Director, Thank you for your interest in using the USECF event coverage for your event. Enclosed you will find USECF insurance information for the 2017 year which can be used for gravel grinders,

More information

WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT This document affects your legal rights. You should read and understand it before signing it.

WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT This document affects your legal rights. You should read and understand it before signing it. WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT This document affects your legal rights. You should read and understand it before signing it. In consideration for receiving permission to participate in

More information

Camp Medical Information & Release Form

Camp Medical Information & Release Form Global Youth Ministry Global Youth Camps 40 Blackhawk Trail Chatsworth, GA 30705 877-251-1800 www.globalyouthministry.org Camp Medical Information & Release Form Name Gender Age Birthdate / / Church/Org

More information

INSURANCE INFORMATION

INSURANCE INFORMATION These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we

More information

SCCA Rally/Solo Release and Waiver Guidelines

SCCA Rally/Solo Release and Waiver Guidelines RISK MANAGEMENT I. Introduction SCCA Rally/Solo Release and Waiver Guidelines These guidelines are intended to provide basic information regarding release and waiver procedures for ALL non-club or SCCA

More information

Camp Braveheart Camper Registration

Camp Braveheart Camper Registration Camp Braveheart Camper Registration 1 Print clearly in ink and complete all blanks. If there is a blank that is not applicable, please write N/A. Incomplete forms cannot be accepted. We will be unable

More information

Renter Agreement for Eagles Landing at Parker Creek

Renter Agreement for Eagles Landing at Parker Creek Renter Agreement for Eagles Landing at Parker Creek This Renter Agreement ("Agreement") is made and effective between The Eagles Landing and its Rental Guests regarding the property known as The Eagles

More information

Karen McCallum. Volunteer- Counselor in Training Applications. Spring Dear Counselor in Training Applicant:

Karen McCallum. Volunteer- Counselor in Training Applications. Spring Dear Counselor in Training Applicant: Volunteer- Counselor in Training Applications Spring 2018 Dear Counselor in Training Applicant: Boardman Park Adventure Day Camp Program prides itself on its reputation for quality and service. This recognition

More information

Craft Vendors. Food Vendors. (Please Print)

Craft Vendors. Food Vendors. (Please Print) February 5-7, 2016 Hard Rock Live Seminole Hard Rock Hotel & Casino Hollywood VENDOR BOOTH APPLICATION Postmark Deadline: December 17, 2015 Craft Vendors Seminole Tribal Elders (60 years old & up)... FREE

More information

MEMBERSHIP CATEGORY (circle one) For current dues please refer to the website Membership page

MEMBERSHIP CATEGORY (circle one) For current dues please refer to the website Membership page Page 1 MEMBERSHIP REGISTRATION RAT ISLAND ROWING AND SCULLING CLUB NAME (print clearly): Date of birth: / / Home phone: ( ) - - Work/Cell: ( ) - - Email: Mailing address (city/ state) (Zip) Today s date:

More information

PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE:

PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Spring Break Camp PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Have you attended Camp C-Woo before? Yes No CWU ID Number Spring

More information

Pocock Rowing Center

Pocock Rowing Center Pocock Rowing Center Office Use QB LGL XL S Code Membership Forms New Member Existing Member Former Member First Name: Last Name: Address: City: St: Zip: Email Address: Cell Phone ( ) Alt Phone: ( ) Gender:

More information

Summer Sailing Registration

Summer Sailing Registration Summer Sailing Registration Date Sailor s Name Birthday Address City State Zip Mothers Name Home # Cell/Work # Fathers Name Home # Cell/Work # Emergency Contact Name Phone # (This person will be in a notebook

More information

RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT

RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT Available with permission from YMCA Services Corporation Copyright 2005 YMCA Services Corporation All Rights Reserved

More information