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Campbellford Paddle

Takeaway Rental

Waiver, Release and Agreement

(Please read completely before signing and ask questions if there is anything you do not understand.)

In consideration of being allowed to participate in any way in Campbellford Paddle ("Campbellford Paddle") lessons, rentals, related events and activities, the undersigned acknowledges, appreciates and agrees on their behalf and the behalf of anyone they allow to use any rented equipment that:

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

2. Stand up paddleboards, kayaks, canoes, pedalboats, leashes, paddles, all equipment used in watersports and the natural surroundings, including water, docks, rocks, and shoreline areas are potentially hazardous objects; and lake and river conditions can change quickly, the water may decrease in temperature rapidly, wave height may increase or decrease, visibility in the water may fluctuate, current may be strong, or depth of water will change, under, above and floating water obstacles such as rocks or debris may be present and I respect the lake and river’s power; and

3. An SAE approved Personal Floatation Device, whistle, SUP leash, or other legally required safety gear, were provided and I acknowledge that Campbellford Paddle has encouraged me to use them appropriately at all times while on the water; and I will not approach any obstacle or object, including but not limited to boat wakes, shorelines, shallow water, rocks, or docks, in an unsafe manor such as remaining in a standing position on a SUP; and

4. Stand up paddling, kayaking, canoeing, pedalboating, and swimming can be strenuous physical activities involving varying depths of water; and I am in average to above average physical condition; and my swimming ability is adequate to engage safely in watersports; and

5. I have no preexisting medical or other condition that would affect the safe participation in these activities; or I have consulted my physician as to the advisability of participating in these activities; and I will inform Campbellford Paddle of any changes in my health or physical condition prior to any lesson or rental; and 

6. 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

7. I understand I am responsible for all damage or loss to the board and equipment including major dings or breakage and I hereby authorize Campbellford Paddle to process the credit card security authorization provided in full payment against rental charges and/or damages and/or failure to return items incurred in association with the rental and use of paddle boards, other water craft such as canoes or kayaks, and equipment.

8.I knowingly and freely assume all such risks, both known and unknown, and hereby release and hold harmless Heather Zak, Mark Malcolm, and Campbellford Paddle, their officers, officials, volunteers, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the activities (“Releases”), with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the releasees or otherwise.

9. This Agreement shall remain in effect for all future lessons, clinics, or rentals from Campbellford Paddle.

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 IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Date: July 23, 2018

First Renter's Name

First Name*

Last Name*

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

First Name*

Last Name*
Second Renter's Date of Birth*
Third Renter's Name

First Name*

Last Name*
Third Renter's Date of Birth*
Fourth Renter's Name

First Name*

Last Name*
Fourth Renter's Date of Birth*
Fifth Renter's Name

First Name*

Last Name*
Fifth Renter's Date of Birth*
Sixth Renter's Name

First Name*

Last Name*
Sixth Renter's Date of Birth*
Seventh Renter's Name

First Name*

Last Name*
Seventh Renter's Date of Birth*
Eighth Renter's Name

First Name*

Last Name*
Eighth Renter's Date of Birth*
Ninth Renter's Name

First Name*

Last Name*
Ninth Renter's Date of Birth*
Tenth Renter's Name

First Name*

Last Name*
Tenth Renter's Date of Birth*
Renter'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*
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Complete only if renting stand up paddleboards
I am renting the following number of stand up paddleboards
One
Two
Three
More than three

If more than three paddleboards being rented give number.
Complete only if renting kayak(s)
I am renting the following number of kayaks
One single kayak
Two single kayaks
More than two single kayaks
One tandem kayak
Two tandem kayaks
Complete only if renting canoe(s)
I am renting the following number of canoes
One
Two
Three
More than three
I will be renting for the following period of time

From

To
Pre Authorization CC Information (Optional if you prefer to provide this information in person in paper format. Information will never be used except within the agreed upon terms in the waiver.)

Number

Name on card

Postal Code associated with card

Expiration Date

Card Security Code (CSC) or Card Verification Value (CVV) on back of your card.
I agree to the use of my card as per the terms of the waiver.*
Yes
No
This is to certify that I, as parent/guardian with legal responsibility for this /these participant/s, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child/s' involvement or participation in these programs as provided above
Parent or Guardian's Name

First Name*

Last Name*

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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