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Viking Surf Camp 

Fort Lauderdale FL 33312

954-806-854

 

  • NOTE: SCROLL ALL THE WAY DOWN TO SIGN ELETRONICALLY.

 

WAIVER, GENERAL RELEASE AND INDEMNITY AGREEMENT

PARTICIPANT / PARENT / GUARDIAN
Program / Activity: Viking Surf Camp, LLC
 
This Waiver and General Release is for the above-mentioned participant with regards to any activity or activities sponsored by Viking Surf Camp,wherever those activities may take place.
In consideration of being given the opportunity to participate in these Activities, I, for myself or my child, my personal representative, assigns, heirs and next of kin:
1. ACKNOWLEDGE, agree and represent that I understand the nature of the activities I am participating in (or that my child is participating in) including the use or operation of any equipment that is necessary to participate in the Activity; and that I / child are qualified to use said equipment. Furthermore, I (or my child) am in good health, and in proper physical condition to participate in all such activities.
2. FULLY UNDERSTAND that:
(a ) My participation in any or all these Activities involves risk and dangers of serious bodily harm or injury, including permanent disability, paralysis, and death (“Risks”);
(b) These Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others, including those participating in the Activities, the condition in which the Activities takes place, or the negligence of the “Releases” named in paragraph 4 below;
(c) There may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and
(d) I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my or my child’s participation in any or all Activities.
3. AGREE AND WARRANT that I will examine and inspect each aspect of the Activities in which I take part and that, if I observe any condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the Activity and will not take part in the Activity until the condition has been corrected to my satisfaction.
 
4 consent to and authorize the use and reproduction of photographs and/or audiovisual materials of myself, my daughter, son, or another minor in my care byViking Surf Camp, LLC  for use in publicity material, whether print or electronic format (Brochures, Newspapers, Website,  Social Media, Facebook, et
5. I HEREBY RELEASE, discharge, and covenant not to sue Viking Surf Camp, LLC  its directors, agents, officers, sponsors, co -sponsors, affiliates, volunteers and employees, as well as other participating parties to the Activities, and if applicable, owners and lessors of premises, on which the Activities take place, (all of the foregoing considered the “Releases” herein) from all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releases or otherwise, including negligent rescue operations. In consideration of yours accepting me ( the adult participant ) or my child ( the child participant / minor ) for participation in the above program, Activity, or sport, I hereby, for myself, my heirs, executors, and administrators, acknowledge that there are inherent risks associated with any activities such as travel by car, bus or airplane, swimming, surfing, skateboarding, playing or the like, accidents or illness in remote places without immediate access to medical facilities, force of nature, including the sun, the wind, and rain. I understand that the description of these activities is not complete and other unknown or unanticipated inherent risks may result in injury or death.
For the consideration stated above, I further agree that in the event that I ( the adult participant ) or my child ( the child participant/minor ) should make any claims against the Releases for damages arising out of the above-named program, activity, or sport, I will personally INDEMNIFY, DEFEND AND HOLD HARMLESS Viking Surf Camp.LLC and officers/directors, agents, employees, representatives, sponsors, co-sponsors, affiliates, successors, City of fort Lauderdale and any other City in the State of Florida and assigns against any and all loss and damage occasioned hereby, including attorney’s fees. Taking place in the State Of Florida.

6 I agree to submit a copy of my driver's license or passport for proof of identity before lessons and present the actual document prior to lesson.

 

 

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*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

Phone*
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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
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.
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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