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ACTIVITY APPLICATION FORM

ALL PARTICIPANTS MUST COMPLETE A WAIVER 


IMPORTANT:

By registering for this activity, you agree that you are in good health with no physical limitations for the activity and that you will obey all rules and safely operate the equipment.

I hereby declare that I am physically fit. I do not, and have not suffered from any of the following conditions, which I understand may lead to a dangerous situation with regard to other persons or myself during operation of a surfboard or skateboard. Epilepsy, fits, severe head injury, recurrent blackouts or giddiness, disease of the brain or nervous system, high blood pressure, lung or heart disease, recurrent weakness or dislocation of any limb, diabetes, mental illness, drug or alcohol addiction, recent back injury, arthritis and severe joint sprains, chronic bronchitis, asthma, rheumatic fever, thyroid, adrenal or other glandular disorder, recent blood donation or any condition that requires regular use of drugs. I hereby declare that I have no physical or mental condition that should preclude me from participating in my chosen activity, that I am not participating against medical advice or treatment, and that I have not been diagnosed by a registered doctor as having a terminal illness. Even if I have a health condition as stated above which I may be unaware, by signing this form I still choose to participate in the activity with Outer Surf and agree to waive all responsibilities to all above- mentioned parties concerning any consequences that would result from my actions. I further declare that in the event that I feel ill or unwell, have any physical complaints whatsoever or if an injury is sustained of any kind during the course of surf or skate lessons, surf or skate camp, parties and events, or Outer Babes surf club, I will notify the owner or appropriate staff member immediately and before leaving the premises.


SURF LESSON, SURF CAMP, SKATEBOARDING LESSON, SKATEBOARDING CAMP, EVENTS, BIRTHDAY PARTY, HIGH PERFORMANCE SURFING PROGRAM, OUTER BABES SURF CLUB WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

Please read and be certain you understand the implications of signing. Express Assumption of Risk Association with Surf Lessons, Surf Camps, Birthday parties, High Performance Program, Outer Babes Surf club and Related Activities

I,

do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with non-motorized (e.g. surf board) and related water sport and land based activities to which I am about to engage, including but not limited to:

1. changing water flows, tides, currents, wave action, and ship’s wakes;

2. collision with any of the following; a. other participants,

b. the watercraft,

c. other watercraft,

d. man-made or natural objects, e. the ocean or sound floor:

3. wind shear, inclement weather, lighting, variances and extremes of wind, weather, temperature and changing swell size;

4. my sense of balance, physical condition, ability to operate equipment, swim, and/or follow directions;

5. collision or other hazard that may result in wetness, injury, exposure to the elements, hypothermia, impact of the body upon water or the ocean floor, injection of water into my body orifices, and/or drowning;

6. the presence of both land and marine insects, flora and fauna;

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 reaction time and increased risk of an accident

I specifically acknowledge that I have read, understand and agree to abide by the guide, instructor and Operational Instructions at all times and that I have been trained in the safe use of water sport equipment to my complete satisfaction, and I am physically and mentally able to participate in the water and other related activities to which I am about to engage.

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

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration of being allowed to participate in the above-described activities, as well as the use of any of the facilities and the use of equipment of the below listed releasees, I hereby agree as follows:

1. To waive and release any and all claims based upon negligence, active or passive, with the exception of intentional, wanton, or willful mis- conduct that I may have in the future against all of the following named persons or entities herein referred to as releasees.

Outer Surf School: Outer Surf, LLC OWNER and INSTRUCTORS SHUTTLE VEHICLE (IF APPLICABLE)

2. To release the releasees, their officers, directors, employees, representatives, agents, and volunteers, vehicles and vessels from liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releasees or otherwise, with the exception of gross negligence. By executing this document, I agree to hold the releasees harmless and indemnify them in conjunction with any injury or loss of life that may occur as a result of engaging in the above activities.

3. By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releasees, other than what is set forth in this Agreement.

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 READ THE ABOVE DECLARATIONS, UNDERSTAND THEM, AND I AGREE TO BE BOUND BY THEM.

SIGNATURE OF ADULT PARTICIPANT OR PARENT/GUARDIAN

DATE July 21, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
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 Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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:*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
How did you hear about us ?
Google
Facebook
Instagram
Word of Mouth
Other
PHOTO/VIDEO RELEASE: I hereby give permission for images of myself and or my child, captured during an Outer Surf camp, lesson, or event through video, photo and digital camera, to be used solely for the purposes of Outer Surf and OuterBabes promotional material and publications, and waive any rights of compensation or ownership thereto. *
Yes
No
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*

Middle Name

Last Name*

Relationship*

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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