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FEATHER RIVER CENTER

A California Nonprofit Corporation

Contract, Indemnification, Release and Waiver-Adult or Minor

The Feather River Center’s activities include physically and emotionally demanding activities. We want to make sure you understand the risk of injury before you decide to participate. It is required that you read the following Legal Document, very carefully, make sure you understand it, fill in all the spaces, and sign it before you begin our program. No person will be allowed to participate without the properly filled out waiver and medical release forms.

PLEASE READ THIS DOCUMENT CAREFULLY BEFORE SIGNING BELOW, THIS AGREEMENT INCLUDES A RELEASE OF CLAIMS.

I am aware in signing this statement for participation in the Feather River Center’s Programs that certain elements are physically and emotionally demanding. This program may include swimming, paddling, crawling, jumping, climbing and other rigorous activities on the water or on the land. I will be working with Feather River Center Instructors and with others in the group. It is possible that I may be injured while participating in the program either because of my own conduct, conduct of others in the group, conduct of Feather River Center Instructors, or the condition of the premises.

In order to be allowed to participate, I voluntarily elect to participate and I affirm that I am free of health conditions that might create undue risk to me or others. I am not under a physician’s care for any undisclosed condition that bears upon my fitness to participate.

I agree to indemnify and hold harmless Feather River Center, its agents and employees from all claims, damages, losses, injuries and expenses arising out of or resulting from participating in the Feather River Center programs. I further agree to release, acquit and covenant not to sue Feather River Center for all actions, causes of action claims or damages including but not limited to, claims of negligence by Feather River Center or any 3rd party, damages in law or remedies in equity of whatever kind.

I agree that the site of any lawsuit and the law governing any such lawsuit shall be Butte County, California and governed by California law. I hereby agree that if Feather River Center is forced to defend any action, lawsuit or litigation by myself, my executors, my heirs or on my family’s behalf, my heirs or executors and I agree to pay Feather River Center costs and attorney fees if it successfully defends such action, lawsuit or litigation.

The terms of this agreement shall continue to be in effect after participation in the program is ended. Should any paragraph or part of this agreement be declared unenforceable by a court of competent jurisdiction the remaining paragraphs or parts shall remain in full force and effect.

I release to Feather River Center the right to use for any purpose any photographic or video recorded image of the participant listed below.

I have adequate health, disability and life insurance for myself and my family.

I hereby give permission for transportation to any medical facility or hospital, and I authorize for any qualified instructor or medical personnel to render necessary emergency medical care for the participant listed below.

I , ________________________________________________________, of my own free will, for my family, my heirs and executors and myself, have read, understand and acknowledge the risks and liability for myself and my family this_______day of _______________, 20____ (Date must be the date of the program)

 

PRINT NAME Participant(s)_______________________________________________________________________

 

Participant/Parent or Guardian Signature ____________________________________________________________

(Parent or legal guardian must sign for all persons under 18 years of age. Proof of age may be required)

 

FEATHER RIVER CENTER

A California Nonprofit Corporation

Contract, Indemnification, Release and Waiver-Adult or Minor

The Feather River Center’s activities include physically and emotionally demanding activities. We want to make sure you understand the risk of injury before you decide to participate. It is required that you read the following Legal Document, very carefully, make sure you understand it, fill in all the spaces, and sign it before you begin our program. No person will be allowed to participate without the properly filled out waiver and medical release forms.

PLEASE READ THIS DOCUMENT CAREFULLY BEFORE SIGNING BELOW, THIS AGREEMENT INCLUDES A RELEASE OF CLAIMS.

I am aware in signing this statement for participation in the Feather River Center’s Programs that certain elements are physically and emotionally demanding. This program may include swimming, paddling, crawling, jumping, climbing and other rigorous activities on the water or on the land. I will be working with Feather River Center Instructors and with others in the group. It is possible that I may be injured while participating in the program either because of my own conduct, conduct of others in the group, conduct of Feather River Center Instructors, or the condition of the premises.

In order to be allowed to participate, I voluntarily elect to participate and I affirm that I am free of health conditions that might create undue risk to me or others. I am not under a physician’s care for any undisclosed condition that bears upon my fitness to participate.

I agree to indemnify and hold harmless Feather River Center, its agents and employees from all claims, damages, losses, injuries and expenses arising out of or resulting from participating in the Feather River Center programs. I further agree to release, acquit and covenant not to sue Feather River Center for all actions, causes of action claims or damages including but not limited to, claims of negligence by Feather River Center or any 3rd party, damages in law or remedies in equity of whatever kind.

I agree that the site of any lawsuit and the law governing any such lawsuit shall be Butte County, California and governed by California law. I hereby agree that if Feather River Center is forced to defend any action, lawsuit or litigation by myself, my executors, my heirs or on my family’s behalf, my heirs or executors and I agree to pay Feather River Center costs and attorney fees if it successfully defends such action, lawsuit or litigation.

The terms of this agreement shall continue to be in effect after participation in the program is ended. Should any paragraph or part of this agreement be declared unenforceable by a court of competent jurisdiction the remaining paragraphs or parts shall remain in full force and effect.

I release to Feather River Center the right to use for any purpose any photographic or video recorded image of the participant listed below.

I have adequate health, disability and life insurance for myself and my family.

I hereby give permission for transportation to any medical facility or hospital, and I authorize for any qualified instructor or medical personnel to render necessary emergency medical care for the participant listed below.

I , ________________________________________________________, of my own free will, for my family, my heirs and executors and myself, have read, understand and acknowledge the risks and liability for myself and my family this_______day of _______________, 20____ (Date must be the date of the program)

 

PRINT NAME Participant(s)_______________________________________________________________________

 

Participant/Parent or Guardian Signature ____________________________________________________________

(Parent or legal guardian must sign for all persons under 18 years of age. Proof of age may be required)

 

First Adventurers Name

First Name*

Middle Name

Last Name*

Phone*
First Adventurers Date of Birth*
First Adventurers Signature*
Second Adventurers Name

First Name*

Middle Name

Last Name*
Second Adventurers Date of Birth*
Third Adventurers Name

First Name*

Middle Name

Last Name*
Third Adventurers Date of Birth*
Fourth Adventurers Name

First Name*

Middle Name

Last Name*
Fourth Adventurers Date of Birth*
Fifth Adventurers Name

First Name*

Middle Name

Last Name*
Fifth Adventurers Date of Birth*
Sixth Adventurers Name

First Name*

Middle Name

Last Name*
Sixth Adventurers Date of Birth*
Seventh Adventurers Name

First Name*

Middle Name

Last Name*
Seventh Adventurers Date of Birth*
Eighth Adventurers Name

First Name*

Middle Name

Last Name*
Eighth Adventurers Date of Birth*
Ninth Adventurers Name

First Name*

Middle Name

Last Name*
Ninth Adventurers Date of Birth*
Tenth Adventurers Name

First Name*

Middle Name

Last Name*
Tenth Adventurers 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(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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