Pickos Water Ski and Wakeboard School

105 Jump Street, Santa Rosa Beach, FL 32459
Tel: (850) 267-3988 | Fax: (888) 880-4502

TODAY'S DATE: April 12, 2024



Please read and be certain you understand the implications of signing.
Express Assumption of Risk Associated with use of Water Skiing/Wake Boarding and Related Activities

I , do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with Water Ski / Wake Board activities, water transportation to and from the Water Ski / Wake Board vessel and related water sport activities to which I am about to engage, including but not limited to:

  1. changing water flow, tides, currents, wave action, and ships wakes;
  2. collision with any of the following; 
    a) other participants, 
    b) the watercraft, 
    other watercraft, 
    man made or natural objects, 
    shuttle boat: 
  3. wind shear, inclement weather, lightning, variances and extremes of wind, weather and temperature;
  4. my sense of balance, physical condition, ability to operate equipment, swim and / or follow directions;
  5. collision, capsizing, sinking, or other hazard that may result in wetness, injury, exposure to the elements, hypothermia, impact of the body upon the water, injection of water into my body 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 reaction time and increased risk of an accident

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 watersports, transportation, and Water Ski / Wake Board activities, as well as the use of any of the facilities, specifically, including water transportation and the use of the 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 misconduct that I may have in the future against all of the following named persons or entities herein referred to as releasees. Owner (Company and / or Individual) Scheduled Boat Identification Number Vessel Name
  2. To release the releasees, their officers, directors, employees, representatives, agents, and volunteers, 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 this Agreement, understand it, and I agree to be bound by it.

I Agree


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 Water Skiing / Wake Board activities:

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 the 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 of which I am unaware, by signing this form I still choose to participate in the activity of Water Ski / Wake Board 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 Water Ski / Wake Board activities, I will notify the Water Ski / Wake Board instructor immediately and before leaving the premises.

I have read the above Declarations, understand them, and I agree to be bound by them.

I Agree

Please select who will be participating...
AdultMinorAdult and a Minor
First Participant's Name

First Name*

Last Name*

First Participant's Date of Birth*
First Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Parent or Guardian's Email Address


Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Child Medical Release

To provide a safe environment for your child, please answer the following questions. 

Allergies food or environmental? If yes, please list them:

Medicine taken on a daily basis? If yes, please list them:

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*

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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