Liability Waiver Form

 

 

Emergency Contact Information

Name: ________________________________________________________________

 

Telephone: (                     )_________________________________________

 

E-mail: _______________________________________________________________

 

 

WAIVER AND RELEASE OF LIABILITY

In consideration of being allowed to participate in any way with Island Marine Adventures, activities, events, and trips, the undersigned acknowledges, appreciates and agrees that:

1.       The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis, drowning and death: and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

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; and,

3.        I willingly agree to comply with 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 to the attention of the captain or operator; and,

4.        I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE AND HOLD HARMLESS Island Marine Adventures and Hans Bongarts, their crew, officials, volunteers, agents, and / or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (all of whom are referred to as "Releases"). WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.  I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISKS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RISKS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 

 

 

Signature:

 

 

Witness:                                                

 

 

                                  

 

Date:

 

 

 

 

FOR PARTICIPANTS OF MINORITY AGE (UNDER 18 AT REGISTRATION) OR WITH A DISABILITY MINOR  (      )  (check if appropriate)

This is to certify that I, as a parent/guardian/doctor with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself my heirs, assigns, and next of kin, I release and agree to indemnify the Releases from any and all liabilities incident to my minor child's involvement or participation in these programs as provided here.

 

 

PERSON WITH A DISABILITY (check here if appropriate)

Island Marine Adventures encourages participation from all individuals (able body and persons with disabilities); but Island Marine Adventures cautions those with disabilities who are involved with the activities of cruising and sailing, as well as their parents, guardians, doctors, etc., that there are risks over and above what an able-bodied individual would face, and that the individuals in question also recognize that the risks involved are worth the benefits that may be received. The captain Hans Bongarts has the last word on participation to ensure the safety and enjoyment of each participant.

 

 

Parent/ Guardian

 

Doctor:

 

 

 

 

Witness:

Date:

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