Loading...

LODI LAKE

CANOE, KAYAK, PEDAL BOAT & STANDUP PADDLEBOARD WAIVER OF LIABILITY

ASSUMPTION OF RISK, WAIVER OF LIABILITY AND HOLD HARMLESS RELEASE AGREEMENT FOR GOOD  AND VALUABLE  CONSIDERATION, including permission to use a pedal boat, canoe, kayak or stand-up paddleboard and related functions  (the “Activity”), agree that I, being at least 18 years old, accept these terms and conditions on behalf of myself and, if applicable as a result of my purchase of rental equipment, on behalf of a minor and/or other adult; for myself, my successors, next of kin, heirs, assigns, estate, executors, and administrators:

1. Agree, that prior to participation in the Activity, I will inspect the facilities, equipment, and areas to be used, and if I believe any of them are unsafe, I will immediately advise the person supervising the Activity, facility, or area;

2. Agree to compensate Headwaters Kayak, Inc. for any lost or damaged equipment that I may cause; up to but not exceeding retail cost of equipment.

3. Acknowledge I fully understand the Activity is hazardous and my participation may involve risk of serious injury or death, including economic losses which may result not only from my own actions, inactions, or negligence, but  also from the actions, inactions, or negligence of others, including, but not limited to, those caused by weather, temperature, a lack of hydration, other canoes, kayaks, motorized or non-­motorized watercraft, equipment, facilities, other kayakers and water users, varying water conditions, varying depth, currents, obstacles, natural or manmade objects;

4. Agree to wear my personal flotation device at all times while participating in the Activity and understand that although I may be wearing my personal flotation device, a personal flotation device cannot guarantee the safety of participants;

5. Agree not to enter any closed areas and understand that entering or participating in the Activity outside the designated area is more dangerous and may be unlawful. If I go outside the boundaries and Headwaters’ staff has to come guide me back inside the boundaries I agree to pay a $25 fee to Headwaters;

6. I understand that Headwaters Kayak, Inc. enforces a No Smoking & No Alcohol policy while operating company kayaks. I understand that I will be subject to a $50 per person fee if I smoke or drink alcohol during the Activity;

7. I understand that I MUST return equipment back to the Headwaters Kayak, Inc. dock by close of business. I understand that I will be subject to a fine of $50 per piece of equipment for any late returns. I agree that prior to participation in the Activity, I will confirm the closing time of Headwaters Kayak, Inc. on the day of the Activity.

8. Certify that I am in good health and have no physical condition that would prevent me from participating in the Activity and that I have sufficiently prepared for participation in this Activity and have not been otherwise advised against participation by qualified medical personnel;

9. Assume any and all risks of personal injuries to myself, including medical or hospital bills, permanent or partial disability, death, and damage to my property, caused by or arising from my participation in the Activity;

10. Agree to allow my image (photo, digital, video, etc.) to be used in published materials and websites that promote the programs of the City of Lodi and Headwaters Kayak, Inc.;

11. Release, waive, discharge and relinquish the City of Lodi and Headwaters Kayak, Inc., jointly and severally, and their respective elected and appointed officials, officers, employees, agents, directors, owners, and volunteers, from any liability, loss, damage, claim, demand or cause of action against them arising from or attributable to my participation in the Activity whether the same shall arise by their negligence or otherwise;

12. Covenant not to sue or present any claim for personal injury, property damage, or wrongful death against the City of Lodi, Headwaters Kayak Inc., or their respective elected and appointed officials, officers, employees, agents, directors, owners, and volunteers, attributable to my participation in the Activity.

I acknowledge that this waiver and release is effective from the date first signed through and including December 31, 2020. I acknowledge that I have read and understand the foregoing and agree to be bound thereby. I understand this document is a legally binding agreement that relieves the City of Lodi and Headwaters Kayak Inc., jointly and severally, and their respective elected and appointed officials, officers, employees, agents, directors, owners, and volunteers named herein from liability for personal  injury, wrongful death, and property damage caused by negligence. Further, I understand that I have given up and released legal rights by signing this waiver, and nonetheless sign voluntarily.

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
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
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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
IF PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT (OR LEGAL GUARDIAN) MUST SIGN. I am the parent or legal guardian of the above-­named participant and he/she has my permission to participate in the Activity. I have read and agree to the provisions stated above for myself and the minor participant. Further I understand and agree that neither the City of Lodi or Headwaters Kayak, Inc. are responsible for supervision of the minor participant and that if I allow the above-­named minor to participate without my supervision, I agree to assume all risks from such participation.
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 Reference
How Did You Hear About Us?*
Friend/Family
Facebook
Instagram
Visit Lodi
Other
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!