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White Water Adventurers, Inc., et al,
PO Box 31 Ohiopyle, PA 15470,
1-800-992-7238,
wwaraft.com

PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

***READ CAREFULLY BEFORE SIGNING***
WAIVER AND RELEASE OF LIABILITY

Inconsideration of White Water Adventurers, Inc., et al, furnishing services and/or equipment to enable me to participate in Whitewater Rafting, boating instruction, mountain biking, shuttle services, fishing, hiking and related travel, I agree as follows:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and/or death.

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, or others, and assume full responsibility for my participation.

3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.

4. I, for myself and on behalf of my heirs, assigns, personal representative and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS White Water Adventurers, Inc. ,et al, its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I hereby authorize White Water Adventurers, Inc., et al, and its photographic/film agents to take and utilize photographs/film of me, without compensation, for the purpose of sale, promotion and advertising.

Dated: November 22, 2019

Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Trip Date *

Trip Time

Booking ID *
Activity (Check all that apply) *
LOWER YOUGH GUIDED
MIDDLE YOUGH GUIDED
UPPER YOUGH
LOWER YOUGH RENTAL
MIDDLE YOUGH RENTAL
BICYCLE RENTAL

Check if you have any of the following conditions:

Health Conditions
Heart Condition
Allergies
Asthma
Diabetes
Other

Current Medications
Have you Rafted Before?*
No
Yes
Biked Before?*
No
Yes
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.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to o receive mailings from White Water Adventurers, Inc., et al. White Water Adventurers, Inc., et al does not sell or provide guest names to anyone.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
CONSENT AND ASSUMPTION OF RESPONSIBILITY FOR MINOR (Required for Participants under the age of 18) (Minor must also complete above section): This is to certify that I understand the nature of the Activity, am familiar with the Minor's experience and capabilities, and believe the Minor to be qualified to participate. I hereby personally accept and undertake, individually and in my own name, all of the obligations stated above specifically including the release, assumption of risk, and hold harmless provisions as to the Releasees of all liability, claims, demands, losses, and damages suffered or alleged to have been suffered or incurred by the Minor or to others resulting from injury to the Minor.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Trip Date *

Trip Time

Booking ID *
Activity (Check all that apply) *
LOWER YOUGH GUIDED
MIDDLE YOUGH GUIDED
UPPER YOUGH
LOWER YOUGH RENTAL
MIDDLE YOUGH RENTAL
BICYCLE RENTAL

Check if you have any of the following conditions:

Health Conditions
Heart Condition
Allergies
Asthma
Diabetes
Other

Current Medications
Have you Rafted Before?*
No
Yes
Biked Before?*
No
Yes
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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