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2024 Release and Waiver of Liability Agreement


RELEASE AND WAIVER OF LIABILITY AGREEMENT

GOOD ONLY FROM JANUARY 01, 2024 TO DECEMBER 31, 2024

 

IN CONSIDERATION, of the opportunity afforded me to participate in actual spring and quarry diving with scuba gear, or other underwater apparatus, such opportunity afford to me at my specific request, in the quarry known as CLOVER CREEK BLUE HOLE QUARRY location on real estate owned by JUDY RISBON and RYAN BURKETT, located in Woodbury Township, Blair County, Pennsylvania, including but not limited to, any and all land of JUDY to which may voluntarily subject myself in participating in spring and quarry diving, with scuba gear, or other underwater apparatus, or exploring, picnicking, parking, hiking, climbing, or any other activity in which the undersigned may engage while on the property described hereinabove.

  1. I knowingly, freely and voluntarily, for myself, my heirs, executors, administrators and assigns, WAIVE any right or cause of action, of any kind whatsoever, arising as a result of my participation in spring or quarry diving, with scuba gear, or other underwater apparatus, and any and all springs or quarries located on adjacent to said described real estate property, or arising as a result of any exploration, picnicking, parking, hiking, climbing, or any other activity which I engage while on this said described real property, from which any liability may or could accrue to JUDY RISBON and RYAN BURKETT;
  2. I assume all risks of injury to myself, including death by drowning or other accident, and to my property, while participating in springs or quarry diving, or in any other activities incidental thereto;
  3. I assume all risks of injury to myself and to my property while presented at the afore described real property during such stated activities.
  4. I, myself and my heirs, executors, administrators and assigns, from the date of this release and waiver agreement, and forever here after, hold the said JUDY RISBON and RYAN BURKETT harmless and blameless for any injury to myself, including death, occasioned by my participation in, or presence at, such activities, whether resulting by or through negligence of JUDY RISBON and RYAN BURKETT, their agents, servant officers of employees. Should I, my heirs, executors, administrators, institute any action against either JUDY RISBON and RYAN BURKETT arising out of injury to myself of property, as a result of these activities, then in that event, I for myself and my heirs, executors, administrators and assigns, hereby agree to pay all cost of such actions, including attorney's fees incurred by them.
  5. Further, it is acknowledged that I hereby agree to release and hold harmless the Laurel Divers and its officers from any and all damages of whatever nature which might be incurred by the undersigned or any other party as a result of their involvement in said activities, and further, to hold Laurel Divers and its officers harmless from any and all damages and costs incurred by it, including but not limited to: reasonable attorney's fees, as a result of any demands, suits, costs, judgments, and/or verdicts resulting from claims made concerning involvement in said activities. The activities stated above shall include but not be limited to dives, dive trips, meetings, picnics, cook-outs, parties, social events, etc. sponsored, organized, or supported by the Laurel Divers and/or their representatives.

I hereby agree to the above conditions.

 

ACKNOWLEDGEMENT and RELEASE of Laurel Divers and its officers:

I the undersigned hereby acknowledge the dangers involved in the sport of SCUBA and avow having attained a national certification in said sport, or be under the immediate supervision of a Certified Instructor. Further, it is acknowledge that I hereby agree to release and hold harmless the Laurel Divers and its officers from any and all damages of whatever nature might be incurred by I, the undersigned, or any other party as a result of their involvement in said activities, and further, to hold Laurel Divers and its officers harmless from any and all damages and costs incurred by it, including but not limited to: reasonable attorney's fees, as the result of any demands, suits, costs, judgements, and/or verdicts resulting from claims made concerning involvement in said activities. The activities stated above shall include but not be limited to dives, dive trips, meetings, picnics, cook-outs, parties, social events, etc. sponsored, organized, or supported by the Laurel Divers and/or their representatives.

 

Rules for Quarry Usage

Before entering the property of Clover Creek Quarry, every person MUST have first correctly filled out and signed a RELEASE AND WAIVER OF LIABILITY AGREEMENT, and have scheduled with Laurel Divers.

NO ONE else will be permitted on the property. NO EXCEPTIONS.

  • Group Leader must sign in at the designated spot upon arrival.
  • DO NOT bother the residents or owners for anything.
  • NO diving along the East Wall.
  • NO swimming.
  • NO fishing.
  • NO jumping or diving off any walls or rocks.
  • NO fires, except in the fire rings at designated areas.
  • NO dogs.
  • NO climbing on rock walls or in trees.
  • NO Camping, except by specific permission.
  • NO children under the age of 12 years old allowed on property.
  • Children between the age of 12 and 18 years, MUST be under the control of parents or adults AT ALL TIMES.
  • ONLY certified divers on the access ramps and the dock.
  • ALL firewood must be free of nails and other foreign material.
  • The speed limit is 10 MPH on all quarry roads.

I the undersigned hereby acknowledge that I have read and will abide by the above rules for quarry usage.


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Certification
Your certification agency*

If "OTHER" selected above, please provide your certification agency

Certification number (use "student" or "non-diver" as appropriate) *

Certification date (use today's date if not certified) *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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