UNITED STATES
CANOE ASSOCIATION
Amateur Athletic waiver and release of liability
read before signing
Name of Event:
AFS Date
of Event: 07/20/08 – 07/24/08
In
consideration of being allowed to participate in any way in the UNITED STATES CANOE ASSOCIATION
athletic sports program, related events and activities, the undersigned
acknowledges, appreciates, and agrees that:
The
risk of injury from the activities involved in this program is significant,
including the potential for permanent paralysis and death; and while particular
rules, equipment, and personal discipline may reduce this risk, the risk of
serious injury does exist; and,
I
KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF
ARISING FROM THE NEGLIGENCE OF THE RELEASEES or other and assume full
responsibility for my participation; and,
I
willingly agree to comply with the stated and customary terms and conditions
for participation. If, however, I
observe any unusual significant hazard during my presence or participation, I
will remove myself from participation and bring such hazards to the attention
of the nearest official immediately; and,
I,
for myself and on behalf of my heirs, assigns, personal representatives and
next of kin, HEREBY RELEASE AND HOLD HARMLESS the UNITED STATES CANOE ASSOCIATION, THE
LOON WORKS AND ADIRONDACK FREESTYLE SYMPOSIUM (AFS) AND HOUGHTON COLLEGE STAR
LAKE CAMPUS CONFERENCE AND RETREAT CENTER, their officers, officials,
agents, and/or employees, other participants, sponsoring agencies, sponsors,
advertisers, and, if applicable, owners and lessors of premises used to conduct
the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH,
or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF
THE RELEASEES OR OTHERWISE.
I
HAVE READ THIS RELEASE OF LIABILITY 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 WITHOUT ANY INDUCEMENT.
X__________________________________________DATE
SIGNED: _____________________
(Participant’s signature)
X____________________________________________________________________________
(Participants name and address. Please print.)
FOR
PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE 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, I release
and agree to indemnify and hold harmless the Releasees from any and all
liabilities incident 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 permitted by law.
X____________________________________________ _____ _________________________
(Parent/Guardian signature) Emergency phone number)
DATE
SIGNED:
__________________________________