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HAPPY MEDIA LLC (DBA LITCHFIELD PADDLE)

95 OLD SOUTH RD

LITCHFIELD, CT 06759

860.567.8820

PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

In consideration of being allowed to participate in related events and activities (the “Activities”) offered by HAPPY MEDIA LLC (dba Litchfield Paddle), I the undersigned, acknowledge and agree that:

1. Paddlesports are inherently dangerous, and the risk of injury from the Activities is significant, including the potential for permanent injury, paralysis, and death. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my participation and my ability to swim. Renter acknowledges that PFD's (lifejackets) are made available and that ALL RENTERS ARE REQUIRED TO WEAR PFD's AT ALL TIMES WHILE USING RENTAL BOATS AND EQUIPMENT. Renter understands that a PFD does not remove all risks of injury or death; nor does PFD use make Kayaking, Paddle Boarding, or Canoeing safe activities. No party related to the Lessor (Happy Media LLC dba Litchfield Paddle), including Owner and Employees, has made any representations regarding the safety, or the risks of the activity. Renter expressly assumes all risks of the activity.

2. I, for myself and on behalf of my heirs, and, personal representatives, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS HAPPY MEDIA LLC (dba Litchfield Paddle) and their respective owners, officers, managers, agents, and/or employees, as well as other participants in the Activities (collectively, the “RELEASES”), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, ACCIDENT OR DEATH I may suffer arising from or in connection with my participation in any Activities, as well as or loss or damage to any other person or property, to the fullest extent permitted by law.

Personal Responsibility

The Participant and his/her legal guardian(s) certify that the Participant has no physical or mental condition that precludes him/her from participating in the Activities and that he/she is not participating against medical advice. The Participant and/or his/her legal guardian(s) understand that the Participant is obligated to follow the rules of the Activities, including wearing a PFD at all times on the water, and that he/she can minimize his/her risk of injury by doing so and through the exercise of common sense and by being aware of his/her surroundings.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, INCLUDING THE RIGHT TO SUE, AND SIGN IT FREELY AND VOLUNTARILY.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Insurance

Insurance Carrier*

Insurance Policy Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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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