City of Akron




TODAY'S DATE: May 27, 2022

I am participating  in the kayak activity with Breakaway Excursions, LLC on City of Akron property.

I am  eighteen  years  of  age  or  older,  and  am  aware  of  and  understand  the  risks  and dangers  involved  in such  activities,  and that unanticipated  and unexpected  dangers  may  arise during  such  activities,  and  I assume  all risks of  injury  to my person  and property,  including disability  or death, that may be sustained  in connection  with the stated associated  activities,  in and about the premises.   I understand and agree that the City of Akron has not undertaken any duty or responsibility for my safety or wellbeing.   I warrant that I am qualified to participate in the activity, am in good health relative to the activity, and am in proper physical condition to participate in the activity.   If I am not eighteen years old or older, then my parent(s) or lawful guardian, as the case may be, has executed this Waiver of Liability and Release and expressly agrees to its terms and conditions.

I, on behalf of myself, my heirs, executors, administrators, successors and assigns, hereby release  and forever discharge  the City of Akron,  its employees,  assignees,  agents, officers  and officials  ("Releasees")  of any  and all liabilities  for any injuries  I might  sustain  or any other claims, demands, actions and causes of action that may occur to me because of, resulting from, or  arising  out  of  my  presence  on  the  premises  and/or  my  participation   in  the  training.    I understand that the City of Akron is not waiving nor do they intend to waive any statutory or common law immunities afforded to them.

The  undersigned   also  hereby  agrees  to  indemnify,  defend,  and  hold  the  Releasees harmless  from  any  and  all  claims,  actions,  suits,  procedures,  costs,  expenses,  damages  and liabilities  including,  but not limited to, attorney's fees, caused  by, arising from, or in any way related to, participant's participation in the kayak activity(ies), except for those arising out of the willful misconduct, gross negligence, or intentional torts of the Releasees, as applicable.

I declare that I have read and fully understand the terms of this waiver and release; that for the sole consideration of said privilege listed herein, I do hereby waive and relinquish all claims, demands, actions and causes of action resulting from my exercising such granted privilege.  I, of my own free will and accord, have executed this waiver and release on the date set forth below.

Breakaway Excursions LLC

TODAY'S DATE: May 27, 2022

PLEASE READ BEFORE SIGNING: In consideration of being permitted to participate in any way in the Breakaway Excursions LLC's, ("BE") teambuilding, sports, recreation, river cleaning, paddling programs and related activities ("Activity") I, for myself, my personal representatives, assigns, heirs, and next of kin understand, agree, warrant and covenant as follows:

1. WARNING AND RISK. I Recognize and acknowledge that there are risks associated with Activities which may include but are not limited to; falls, contact with other participants, the effects of weather, misuse or failure of equipment, drowning or collision with another craft, person, or object on land or in the water which could result in damage to personal property and serious bodily injury, including permanent disability, paralysis, and death ("Risks").

2. ACKNOWLEDGEMENT OF RISK: I knowingly and freely accept all risks and injury that may occur while participating in the Activities and all associated activities regardless of whether or not caused in whole or in part by the negligence or fault of BE, it's agents, employees, members or other guests.

3. EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY: In recognition of the risks of the Activity I or my (child/ward) will engage in, I confirm that I am or my (child/ward) is in good health and are mentally and physically capable of participating in the Activity and/or using equipment. I/we participate willingly and voluntarily and I assume responsibility for damage to or loss of my/our personal property. I also assume all risk(s) included by not limited to sprains; strains, torn muscles, ligaments and/or tendons; fractured or broken bones; cuts, wounds, scrapes, abrasions, and/or contusions; dehydration, oxygen shortage; head, neck and/or spinal injuries; insect bite or allergic reaction, infection; shock, paralysis; and/or death.

4. AUTHORIZATION: I am aware staff/volunteers may provide support for this Activity, including but not limited to the administration of: first aid, CPR (Cardiopulmonary Resuscitation), or the use of AED (Automated External Defibrillator). I authorize any such staff/volunteers to assist me (or my child/ward) and/or to provide such assistance as, in the opinion of such person, may be necessary or appropriate. I also authorize on behalf of myself (or my child/ward) for BE to obtain first aid and/or medical treatment at the nearest and most adequate facility of BE's choice. I either have appropriate insurance or, in its absence, agree to pay all costs of rescue and/or medical services as may be incurred on me or my (child/ward's) behalf. I further give my permission for the free use of my or (my child/ward) name, voice recording, photo or video in any purpose including, social media, BE's webpage, marketing and/advertising materials.

5. COVENANT OF GOOD FAITH: I recognize that BE, as provider of services, will operate under a covenant of good faith and fair dealings, but that BE may find it necessary to terminate an activity due to forces of nature, medical necessities, problems in the group; and/or refuse or terminate the participation of any person BE judges to be unsafe, or incapable of meeting the rigors or requirements of participating in the activity. I accept BE's right to take such actions for the safety of myself and/or other participants. I acknowledge that no guarantees have been made with respect to any Activity.

6. RELEASE: In consideration of, and in recognition of the inherent risks of the Activity, I assume full responsibility for my (child/ward) participation in this Activity and agree for myself (and on behalf of my minor child/ward) to fully release, waive, hold harmless and indemnify BE, its owners, employees, agents, sponsors, other guests, and volunteers from any and all claims related to any illness, injury, including loss of life, property damage or loss of any other description which I (or my child/ward) may sustain arising out of, or in any way associated with my (child/ward) participation in any Activity.

I have fully read this waiver and release agreement and fully understand its terms, and I understand that I have given up substantial rights by signing it and sign it freely and voluntary without inducement.


First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
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

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A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*
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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