Assumption And Acknowledgement Of Risks And Release Of Liability Agreement Template printable pdf download

PAYNE IN THE REAR, INC. WAIVER

ASSUMPTION AND ACKNOWLEDGEMENT OF RISKS

AND

RELEASE OF LIABILITY AGREEMENT

In consideration of being allowed to participate in water sport events and activities and or being provided with

watersport recreational property or services for myself and any minor children for whom I am a parent, legal

guardian or otherwise responsible, and for my/our heirs, personal representatives or assigns:

1) ACKNOWLEDGEMENT OF RISKS: Acknowledge that some, but not all, of the risks of participating in the

watersport activity, include; (1) Changing water flow, tides, currents, wave action and boats’ wakes; (2)

Collision with any of the following: other participants, the watercraft, other watercraft and manmade or natural

objects; (3) Wind shear, inclement weather, lightning, variances and extremes of wind, weather and

temperature; (4) My sense of balance, physical coordination, ability to operate equipment, swim and/or follow

directions; (5) Collision and/or drowning; (6) The presence of insects and marine life forms; (7) Equipment

failure or operator error; (8) Heat or sun related injuries or illnesses, including sunburn, sunstroke or

dehydration; (9) Fatigue, chill and or dizziness which may diminish my/our reaction time and increase the risk

of an accident.

2) EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY: Agree to assume responsibility for all the risks

of the activity, whether identified above or not, (EVEN THOSE RISKS ARRISING OUT OF THE

NEGLIGENCE OF THE RELEASEES NAMES BELOW). My/our participation in the activity is purely

voluntary. I assume full responsibility for myself and any of my minor children for whom I am responsible, for

any bodily injury, accident, illness, paralysis, death, loss of personal property and expenses thereof as a result of

any accident which may occur while I/we participate in the activity (EVEN IF CAUSED, IN WHOLE OR IN

PART, BY THE NEGLIGENCE OF THE RELEASEES NAMED BELOW).

I agree to wear a U.S. Coast Guard approved personal flotation device (life jacket) while participating in the

activity or riding in any watercraft.

3) RELEASE: I hereby release Payne in the Rear, Inc., its principals, directors, officers, agents, employees, and

volunteers, their insurers and each and every land owner, municipal and/or governmental agency upon whose

property an activity is conducted (“owner”) and their insurers, if any, (Collectively “Releases”) FROM ANY

AND ALL LIABILITY OF ANY NATURE FOR ANY AND ALL INJURY OR DAMAGE (INCLUDING

DEATH) TO ME OR MY MINOR CHILDREN AND OTHER PERSONS as a result of my/our participation in

the activity, EVEN IF CAUSED BY THE NEGLIGENCE OF ANY OF THE RELEASEES NAMED ABOVE,

OR ANY OTHER PERSON (INCLUDING MYSELF).

I HAVE READ THIS ASSUMPTION AND ACKNOWLEDGEMENT OF RISKS AND RELEASE OF LIABILTY

AGREEMENT. I UNDERSTAND THAT BY SIGNING THIS DOCUMENT, I AM WAIVING VALUABLE

LEGAL RIGHTS, INCLUDING ANY AND ALL RIGHTS I MAY HAVE AGAINST THE OWNER, THE

OPERATOR NAMED ABOVE, OR THEIR EMPLOYEES, AGENTS, SERVANTS OR ASSIGNS.

Participant’s Name (printed)___________________________________________________Age________

Signature____________________________________________________________Date______________

In emergency contact:____________________________________________________________________

List any known allergies to plants, insects or medications (if more space is required, attach extra pages):

______________________________________________________________________________________

If participant is under 18, the parent or legal guardian must also sign_______________________________

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Assumption And Acknowledgement Of Risks And Release Of Liability Agreement Template