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PO Box 411, Bellport, NY 11713

Get Up Stand Up NY Inc.: Acknowledgment and Assumption of Risks; Waiver of Claims; Release of Liability

This is a legal document that may affect your rights in the event of an accident or dispute. Please read the entire agreement and and be certain you understand the implications of signing.

I hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with stand up paddling, related water sport activities, recreational sports, physical fitness, and/or athletic training in which I am about to engage. These risks include but are not limited to the following:

            1)  Change of water flow, tides, currents, wave action, and ship’s wake

            2) Collision with other participants; the stand-up paddle board; boats; or other man-made or natural objects

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

            4) My own sense of balance, physical condition, ability to operate board, swim and/or follow directions

            5) Collision, capsizing, sinking, or other hazard that my result in wetness, injury, exposure to the elements, hypothermia, impact upon the water, injection of water into my bodily orifices, 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, sun stroke or dehydration

            9) Fatigue, chill and/or decreased reaction time and increased risk of accident

COVID-19 REPRESENTATION AND RELEASE: In addition, I understand that an inherent risk of exposure to COVID-19 exists in any public place where people are present. I voluntarily assume any risk of exposure to COVID-19. I hereby release Get Up Stand Up NY, Inc. and its staff, officers, agents, instructors, owners, and volunteers from any claim of liability arising from the risk of exposure to COVID-19. I represent that neither I nor any member of my household has experienced fever, shortness of breath, fatigue, dry cough, or any other symptoms of COVID-19 in the past 14 days.

I specifically acknowledge that I have read, understand and agree to abide by the Get Up Stand Up NY, Inc. operational instructions at all times and that I have been trained in the use of Get Up Stand Up NY, Inc. equipment to my complete satisfaction, and that I am physically and mentally able to participate in the activities in which I am about to engage. I agree to comply with the rules, regulations, and instructions of Get Up Stand Up NY Inc. and its staff members during Get Up Stand Up NY Inc. activities. 

I further affirm that I understand that the activities in which I may engage with Get Up Stand Up NY, Inc. may be physically strenuous and involve the dangers inherent in participation in such activities. I am aware that any strenuous physical activity involves certain risks.

I hereby personally assume all risks in connection with the activities in which I will participate with Get Up Stand Up NY, Inc.  I release Get Up Stand Up NY Inc. and its staff, officers, agents, instructors, owners, and volunteers from any and all claims for personal injury, property damage, or wrongful death by me or my family, estate, heirs, or assigns, including claims for negligence, active or passive, except to the extent that any such claim arises from an accident or injury caused by the intentional, wanton, or willful misconduct of Get Up Stand Up NY Inc. or its staff, officers, agents, instructors, owners, or volunteers. 

I hereby give permission to Get Up Stand Up NY Inc. and its staff, instructors, owners, or volunteers to provide emergency medical care to me in the event of injury or illness.

By entering into this agreement, I am not relying on any oral or written representation made by Get Up Stand Up NY Inc. or its staff, officers, agents, instructors, owners, or volunteers.

I accept responsibility to verify with my physician that I have no physical or psychological problems that would prohibit my participation in activities at or under the sponsorship of Get Up Stand Up NY Inc. 

I specifically waive any defense insofar as this contract is concerned that may arise as result of any state or local law and /or regulation or policy that may impact its enforceability.

I hereby declare that I am of legal age and am competent to sign this Agreement, or, if not, that my parent or legal guardian shall sign on my behalf and that my parent or legal guardian is in complete understanding and concurrence with this Agreement. 

I have fully informed myself of the nature of the risks inherent in the activities in which I will participate with Get Up Stand Up NY Inc., including but not limited to stand-up paddleboarding and personal training, and I have read the foregoing before signing below. I have read this Agreement, understand it, and I agree to be bound by it.

I Agree

 


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
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*
Check to receive information, news by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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 Information
Have you ever paddleboarded before?*
Yes, many times
Yes, one to 2 times
Never
Do you know how to swim?*
Yes
No
Are you currently physically active?*
Yes
No
Do you have any past/current injuries?*
Yes
No

If yes, please list here
Has your doctor ever said you have heart trouble?*
Yes
No
Do you frequently have pain in your heart and chest?*
Yes
No
Do you often feel faint or have spells of severe dizziness?*
Yes
No
Has your doctor ever said your blood pressure was too high?*
Yes
No
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse through exercise?*
Yes
No
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
Yes
No
Are you over the age of 65 and not accustomed to vigorous activity?*
Yes
No
Do you have any special needs or additional health information to share?*
Yes
No

Please list any special needs, allergies or further comments
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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