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WAIVER AND RELEASE OF LIABILITY

EVENT NAME:  St. Lawrence River Dragon Boat Challenge, Presented by Claxton-Hepburn Medical Center

EVENT DATE:  7/14/2018

 

In consideration of being allowed to participate in any way in the St. Lawrence River Dragon Boat Challenge, the related event above and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury from the activities involved in this program is significant including the potential for accidental drowning or death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and I assume full responsibility for my participation; and

I willingly agree to comply with the stated and customary terms and conditions for participation.  If, however, 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; and

I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release and hold harmless Claxton-Hepburn Medical Center, Town of Waddington, NY,  New York Power Authority, St. Lawrence University, and Dynamic Dragon Boat Racing, LLC, their officers, directors, agents, and/or employees, volunteers, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (Releasees), with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of those parties or otherwise.

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 THIS AND DO SO VOLUNTARILY, WITHOUT INDUCEMENT.

I Agree

July 18, 2018

First Paddler's Name

First Name*

Last Name*

Phone*
First Paddler's Date of Birth*
I certify that I am 18 years of age or older
First Paddler's Signature*
Second Paddler's Name

First Name*

Last Name*

Phone*
Second Paddler's Date of Birth*
Second Paddler's Signature*
Third Paddler's Name

First Name*

Last Name*

Phone*
Third Paddler's Date of Birth*
Third Paddler's Signature*
Fourth Paddler's Name

First Name*

Last Name*

Phone*
Fourth Paddler's Date of Birth*
Fourth Paddler's Signature*
Fifth Paddler's Name

First Name*

Last Name*

Phone*
Fifth Paddler's Date of Birth*
Fifth Paddler's Signature*
Sixth Paddler's Name

First Name*

Last Name*

Phone*
Sixth Paddler's Date of Birth*
Sixth Paddler's Signature*
Seventh Paddler's Name

First Name*

Last Name*

Phone*
Seventh Paddler's Date of Birth*
Seventh Paddler's Signature*
Eighth Paddler's Name

First Name*

Last Name*

Phone*
Eighth Paddler's Date of Birth*
Eighth Paddler's Signature*
Ninth Paddler's Name

First Name*

Last Name*

Phone*
Ninth Paddler's Date of Birth*
Ninth Paddler's Signature*
Tenth Paddler's Name

First Name*

Last Name*

Phone*
Tenth Paddler's Date of Birth*
Tenth Paddler's Signature*
Paddler'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 receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Team Info

Team Name or Captain *
T-Shirt size (unisex) *
Small
Medium
Large
X-Large
XX-Large
XXX-Large
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*

Last Name*

Relationship*

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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