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Please complete the following Up a Creek waiver for your participating child(ren).

Acknowledging participation in the activities at Up a Creek, the undersigned, on his/her own behalf, and on behalf of any executors, heirs, successors and assigns, hereby acknowledges and agrees as follows: The undersigned fully assumes all risks, known and unknown, associated with participation in activities at Up a Creek, and waives all claims for damage to personal property or injury to person arising from such participation. This release and waiver covers risk of death, serious injury, and property loss whether arising from a) negligence or carelessness on the part of the persons or entities being released and other participants, or b) dangerous or defective equipment. The undersigned certifies that he or she is physically fit and may participate in the activities available at Up a Creek, and has not been advised to the contrary by a qualified medical professional. The undersigned on his or her behalf and on behalf of any executors, heirs, successors and assigns, hereby releases, discharges, and holds harmless any authorized entity doing business as Up a Creek, including its officers, agents, employees, representatives, and all affiliates, from any and all claims, damages, or liability arising from death, disability, personal injury, property damage, theft, or any kind of action. The undersigned agrees to abide by the rules and conditions of participation posted at or explained by an employee at Up a Creek. If the undersigned experiences any significant hazard or injury during such participation, the undersigned will promptly inform an employee of Up a Creek. The undersigned acknowledges that this release and waiver of liability form will be used and relied upon by Up a Creek, and that it will govern the undersigneds actions and rights. I further agree to supervise my children and the children in my care, and not allow them to act recklessly or inappropriately in such a way that would endanger themselves or others around them. I understand Up a Creek retains the right to ask me and/or other guests to leave if deemed necessary and am due no compensation or refund.

First Participant's Name

First 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*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
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Parent(s) or 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.
Parent or Guardian's Name

First Name*

Last Name*

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