Adult Release And Waiver Of Liability, Assumption Of Risk, And Indemnity Agreement Form printable pdf download

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

FOR HARPERS FERRY ADVENTURE CENTER INC ZIPLINE AND ADVENTURE PARK ACTIVITIES

ADULT PARTICIPANT AGREEMENT

In consideration of being allowed by Harpers Ferry Adventure Center Inc. (“HFAC”), to participate in its zipline,

adventure park and other activities and use its services, I hereby acknowledge, represent and agree that I have read and

fully understand all of the terms of the separate document entitled Release and Waiver of Liability, Assumption of Risk,

and Indemnity Agreement for Harpers Ferry Adventure Center Inc Zipline and Adventure Park Activities (“Release”).

I acknowledge and agree that the Release’s provisions are organized under paragraphs numbered and titled as follows:

1. Scope of the Activities Covered and Participant Warranty

2. Risks of Activities and Assumption of Risk

3. Waiver of Liability, Release, Indemnity and Covenant Not to Sue

4. In the Event of Non-Enforcement of Waiver and Release: Agreed Duties of Participant and HFAC, Agreed Bar

of Claim When Participant Has Contributed to Occurrence, and Agreed Indemnity of HFAC

A. As to the Participant

B. As to HFAC

C. Bar of Participant from Claim When Participant Has Contributed to Injury or Damage, and

Participant’s Agreed Indemnity of HFAC for Any Third-Party Claim Arising from Participant’s Actions

5. Participant’s Own Responsibility for Personal Property

6. Permission for Use of Publicity Items

7. Choice of Legal Forum, Application of this Agreement, and Severability of Provisions

8. Electronic Agreement (Applicable to Electronically Signed Agreement Only)

I acknowledge and agree that all of the provisions of the Release in their entirety are adopted and incorporated by

reference in this agreement. I also acknowledge, agree to and commit to abide by all of the provisions of the Release.

I have read and understand this Agreement and the Release and Waiver of Liability, Assumption of Risk, and

Indemnity Agreement for Harpers Ferry Adventure Center Inc Zipline and Adventure Park Activities, fully

understand their terms, understand that I have given up substantial rights by signing them, and voluntarily agree

to be bound by their terms. My signature applies to all pages of both agreements. YES_______

NO__________(CHECK ONE)

SIGNATURE OF PARTICIPANT: __________________________________________ DATE:___________

Print Legibly and Fully Complete the Following Blank Spaces

Last Name: ________________________________First Name:_______________________________

Group Name (If Applicable):__________________________________________________________

Address:_______________________________________________________ Zip:____________________

City:____________________________________ State: ____________________

Home Phone: _____________________________ Mobile Phone: ____________________________

Age: ___________Date of Birth: ___________

Email: _____________________________________

You will be

added to our enews list for events, news, and special offers. If you later decide you do not want to receive this info, you can

unsubscribe.

I have prescribed medications on my person for use in a crisis: (If yes, you are responsible for advising your guide

of this on any guided trip.) Yes:__________ No: _______(check one).

HOW DID YOU HEAR ABOUT US? Google___Other Internet Search___Past/Repeat Customer___Referral___

Facebook ___ Washington Post ____ Living Social ___ Radio/TV ____Harpers Ferry KOA____

Other print ad (please list):______________________Other (please list):____________________

Adult Participant Agreement (Paper) – HFAC Zipline and Adventure Park Activities

Version 5/14

Adult Release And Waiver Of Liability, Assumption Of Risk, And Indemnity Agreement Form

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