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Encinitas Surf Lessons Liability Release

Liability Release Form for Encinitas Surf Lessons

In consideration of being allowed to participate in any surfing instruction / Surf/Ocean therapy and / or related activities, I acknowledge and fully agree to the following disclosures:

1. Risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist.

2. I Acknowledge That Surfing May Be Dangerous And I Accept And Assume Such Risks, both known and unknown, EVEN IF ARISING FROM THE NEGLEGENCE OF THE RELEASEES or others, and assume full responsibility for my participation: I am aware that open water activities in general, and surfing specifically, involves inherent risks.

3. I willingly agree to release ENCINITAS SURF LESSONS and the City of Encinitas or any of its employees from responsibility and waive all my rights to take any legal action against them. If I observe any unusual or significant hazards during my presence or participation in this activity I understand that it is my responsibility to remove myself from participating and bring such to the attention of the nearest official immediately.

4. I Waive My Right To Sue ENCINITAS and the City of Encinitas: In consideration for ENCINITAS SURF LESSONS agreeing to provide me with surfing instructions / Surf/Ocean therapy and allowing me to participate in this lesson, I agree that I shall not make a claim or bring any action against, sue, or hold responsible the City of Encinitas and ENCINITAS SURF LESSONS, its owners, officers, agents, employees, associates, representatives, (referred to collectively in this agreement as " ENCINITAS SURF LESSONS ") or expect, require, or pursue them, to be held accountable for any damages. I voluntarily agree to release, discharge, and hold harmless ENCINITAS SURF LESSONS from and against any and all claims of liability, even those arising out of their negligence, fault, recklessness, or any other act or omission which causes me damages, illness, injury, disease, or death, of any nature in any way connected with my participation in this activity. I also expressly agree to release and discharge ENCINITAS SURF LESSONS from any act or omission, excluding acts of wanton or gross negligence, in rendering or failing to render any type of rescue, emergency or medical services.

5. Promotional Use of Images: I hereby agree that ENCINITAS SURF LESSONS may use film or photographic records of this surfing class or lesson for its promotional and/or commercial purposes without compensation to me, and I consent to the use of my name and likeness for such use in any media now known or not known.

6. I agree to replace and / or compensate for all or any equipment damaged due to my negligence.

7. I, for myself and on behalf of my heirs assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS, ENCINITAS SURF LESSONS , their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("Releasee"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damages to personal property, WHETHER ARISING FROM THE NEGLEGENCE OF THE RELEASEE OR OTHERWISE, to the fullest extent permitted by the law.

Please note: CANCELLATIONS PRIOR TO 24 HOURS BEFORE A BOOKING WILL RESULT IN FULL LESSON CHARGE. TIME LIMIT TO USE PACKAGE OF 3 LESSONS: 6 WEEKS / TIME LIMIT FOR 6 LESSONS: 3 MONTHS. NO REFUNDS AFTER 3O DAYS OF DEPOSIT DATE

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARY WITHOUT ANY INDUCEMENT.

 

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*
MINOR(S) (UNDER THE AGE OF 18 AT THE TIME OF REGISTRATION) This is to certify that, as parent of guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasee, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless JASON'S SURF AND THERAPY and affiliates from any and all liabilities incident to me or my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
Parent or Guardian's Name

First Name*

Middle 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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