Loading...

Safari Town Surf Shop Lessons & Rentals

Release of Liability & Assumption of Risk Agreement 




I the undersigned, hereby state that I am aware of the potential dangers involved with surfing, bodyboarding, skimboarding, stand up paddle boarding, and kayaking on the Oregon Coast (rocks, strong currents, marine wildlife, etc). By signing this form, I take full responsibility for any accident that may occur to myself, any member of my family, or group, or minor that I am signing for. 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. I promise not to hold Safari Town Surf Shop, or its affiliates, officers, agents, or employees liable for any accident that may occur in or out of the water. I also agree to pay for any lost, damaged, or stolen equipment. By signing below I also understand that it is my responsibility to return all equipment in the same condition that I received it. 

SAFARI TOWN RENTAL ASSUMPTION OF RISK, WAIVER AND RELEASE AGREEMENT

Assumption of Risk: I understand and accept that by renting this equipment and participating in these activities it exposes me to many hazards and may entail personal injury (including but not limited to severe spinal or head injury), unavoidable risk of death, and loss of or damage to property. I also understand I should be in good physical health to participate . I choose to participate in spite of these risks and hereby assume all risk of injury, or loss of life, and loss of or damage to property arising out of renting this equipment and participating. I understand the inherent risk involved in using this equipment, and accept full responsibility for any and all such damage or injury which may result.

Waiver and Release: In consideration of Safari Town renting me this equipment, I specifically release and forever discharge Safari Town Surf Shop and its affiliates, officers, agents, and employees from any and all liability or claims for injury, illness, death or loss of or damage to property which I may suffer while renting this equipment, and participating in this activity. This discharge specifically includes, but is not limited to, liability or claims for injury, illness, death or damage caused by the negligence of Safari Town Surf Shop or its affiliates, officers, agents, or employees. It is my intent by the Waiver and Release Agreement to release Safari Town Surf Shop and hold it harmless from all liability for any such property loss or damage, personal injury or loss of life, whether caused by the negligence of Safari Town. In signing this document, I fully recognize that if injury, illness, death or damage occurs to me while I am engaged in renting this equipment and participating, I will have no right to make a claim or file a lawsuit against Safari Town Surf Shop or its affiliates, officers, agents or employees, even if they or any of them negligently cause my injury, illness, death or damage. 

I understand it's my responsibility to return all rental equipment in the same condition in which I received it. 

I Agree

I understand it is my responsibility to check equipment and notify Safari Town clerk of any damages before leaving the store. 

I Agree

I agree to pay for any damaged equipment, and for any lost or stolen equipment at the shop rates 

I Agree

I have read the rip-current flyer.

I Agree

 

December 9, 2022



First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Legal Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Additional Information

Date out:

Due In:

Time due in:
Item Rented
Surfboards
Stand-Up-Paddle-Boards
Kayaks
Fat Tire Bikes
Wetsuits
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 Legal Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
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 Legal Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Legal Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Legal 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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!