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ALL MEMBERS INCLUDING MINORS MUST SIGN A YEARLY WAIVER

INDIVIGUAL Waivers must be filled out for EACH Family member, You can use 1 waiver to fill out all family members

READ before signing:
In consideration of being permitted to participate in any way in the Yonkers Paddling and Rowing
Club (hereafter YPRC) sport’s and recreation program and related activities(Activities) I, for
myself, my personal representatives, assigns, heirs and next of kin:
1. Acknowledge, agree and represent that I understand the nature of paddle sports and related
activities and that I am qualified, in
good health, in proper physical condition to participate in such activity and willingly agree to
comply with the stated and customary terms and conditions of participation. I further agree and
warrant that if at any time I believe conditions are to be unsafe, I will immediately discontinue
further participation in the Activity. If I decide to leave early and not complete the
trip/Activity as planned, I assume all risks inherent in my decision to leave.

2. Fully understand that: a) Paddle sports and related activities INVOLVE RISKS AND DANGERS OF
DAMAGE TO PERSONAL PROPERTY AND SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS
AND DEATH (“RISKS”); b)these Risks and dangers may be caused by my own actions or inactions, the
actions and inactions of others participating in the
Activity, the condition in which the Activity takes place, or the NEGLIGENCE OF THE “RELEASEES’
NAMED 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 I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS
AND
DAMAGES I incur as a result of my participation or threat of the minor in the Activity. The signed
individual hereby grants Yonkers Paddling and Rowing Club and all partners, sponsors and affiliates
the permission to use your likeness in any method they deem necessary, including for marketing
purposes.

3. HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE THE YPRC, their directors, agents, officers,
members,
instructors, volunteers, employees, other participants, any sponsors, advertisers and, if
applicable owners and lessors of premises   on which the ACTIVITY takes place,(each considered one
of the Releasees herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, INJURIES, DAMAGES TO
PROPERTY, OR OTHER DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO
BE CAUSED IN WHOLE OR IN PARTBY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE , INCLUDING
NEGLIGENT RESUE OPERATIONS; AND I FURTHER AGREE that if. Despite this RELEASE AND WAIVER OF
LIABILITY,
ASSUMPTION OF RISK , AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any
of the releasees, I will INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES from any
litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result
of such claim.

4. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP
SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF
ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE
GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE
LID THE BALANCE, NOTWITHSTANDING SHALL CONTINUE IN FULL FORCE AND EFFECT.

 

First Participant's Name

First Name*

Last Name*

Phone*
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*
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*
Uncheck to not receive information and news, by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
PLEASE provide your current ACA 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*

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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