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Florida Xtreme Adventures

ACCIDENT WAIVER AND RELEASE OF LIABILITY

I acknowledge that this athletic event is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. I realize that liability may arise from ordinary negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwise by a qualified medical person.

I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident, and/or illness during the completion of this competition.

I acknowledge that this Accident Waiver and Release of Liability form will be used by the holders, sponsors and organizers, in which I may participate and that it will govern my actions and responsibilities.

The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I understand that this competition has no staff or personnel on sight. I understand that it is my own decisions as to complete this course at the specific time of my choosing, and that I have reasonably prepared for the risks associated with the course and area.

Read before signing:

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter occur to me including my traveling to and from this event, the following entities or persons: Florida Xtreme Adventures. Their directors, officers, employees, volunteers, representatives, and agents, the event holders, event sponsors, event volunteers, and all city, county, and state governments; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event, whether cause by the ordinary negligence of releases or otherwise.

I hereby certify that I have read this document; and, I understand it’s content.

First Racer's Name

First Name*

Last Name*

Phone*
First Racer's Date of Birth*
First Racer's Signature*
Second Racer's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.


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 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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