Loading...

KAYAK ADVENTURES WORLDWIDE LIABILITY WAIVER 

COMPLETION REQUIRED FOR PARTICIPATION

PARTICIPATION AGREEMENT
Including Acknowledgment and Assumption of Risks and Agreements of Release and Indemnity

By signing this agreement, I understand I am giving up important legal rights, including my right to sue Kayak Adventures Worldwide, LLC (hereinafter referred to jointly as “the company”) or their agents or employees, for any injury or death I may suffer as the result of my participation in the activities associated with my trip, class, or rental.

For and in consideration of the opportunity to participate in an activity or class of the company, the undersigned acknowledges and agrees as follows:

ACTIVITiES AND RISKS

Activities, classes, and use of the company’s rental equipment (together and separately, “activity” or “activities”), offered by the company may be dangerous. I understand and acknowledge that the activity in which I am about to voluntarily engage or observe includes certain known and unknown risks which can result in injury, death, illness, or disease, including physical or mental damage to myself, my property, and to others and to their property. Some of the dangerous activities include: 1) sea kayaking, and the use of other watercraft including charter boats, and the handling, including loading and unloading, of all watercraft; 2) glacier travel and/or hiking; 3) living in and hiking in a wilderness or near-wilderness environment; 4) traveling to and from expedition sites, by air, land or water. Some of the inherent risks of these activities include, but are not limited to: 1) slips and falls due to loss of footing or balance during loading or unloading of water craft resulting in injury, exposure to water, or drowning; 2) exposure to inclement and unpredictable weather and extremes of wind, rain and temperature which can result in hypothermia or death; 3) loss of control and/or capsizing of the water craft due to poor balance, physical condition or coordination, inclement weather, rapids and dangerous water conditions, or collisions with objects including overhanging or submerged or semi-submerged objects, trees, branches, cliffs, rocks, animals, plants, other water craft, float planes, docks and pilings which can result in injury, hypothermia, drowning and death; 4) negligent acts by the company, its agents or employees; 5) negligent acts by participants or third parties; 6) defects in equipment or property supplied by the company or other persons; 7) my own physical and mental condition or my own negligent acts or omissions; 8) the unavailability of immediate medical of emergency treatment in case of injury; 9) poor condition of roads, trails, waterways, terrains, or areas surrounding camp; 10) allergic reaction, injury, death or disease resulting from exposure to insects and/or animals; and 11) injury resulting from the discharge of firearms. I understand that the company has attempted to determine reasonably which water taxi, air taxi, or other transport operator to use, and I will not hold the company responsible for any damages to myself or my property, related to the use of a transport operator. These risks are inherent to the activities and classes of the company; that is, they are such an integral part of the activities and classes that, without them, the activities and classes would lose their essential character, appeal and value. I understand and acknowledge that the above is not a complete or exhaustive list of the known or unknown risks of my participation in activities at any location of the company.

EXPRESS ACKNOWLEDGEMENT AND ASSUMPTION OF RISKS

I agree to assume and accept all responsibility and risk for injury, death, illness, disease, or damage to myself or my property arising from my participation in activities of the company, whether or not those risks are described above, and whether they are inherent or otherwise. I further agree to accept and assume all responsibility for risk of injury, death, illness, disease, or damage to other guests of the company, spectators, or third parties caused by my participation in activities or classes offered by the company, or use of the company’s rental equipment. I understand and acknowledge that no major medical insurance benefits will be provided to me by the company if I am injured while participating in the company’s activities.

I AGREE TO FULLY RELEASE AND INDEMNIFY THE COMPANY

I agree not to sue the company and I hereby voluntarily release and forever discharge the company, its owners, agents, and employees, (“Released Parties”) with respect to any and all liability, claims, demands, or lawsuits for injuries, death, illness, disease, or damage to myself or my property which are related to or arise out of my enrollment or participation in the company’s activities, including damages caused by the negligent acts or omissions of a Released Party. I further agree to defend, indemnify, and hold harmless the Released Parties from all damages, costs and attorney’s fees in connection with any claims for damages which I may suffer, or which I may cause, in whole or in part, to other participants, spectators or other third parties in the course of my enrollment or participation in the company’s activities.

I UNDERSTAND THAT I AM GIVING UP LEGAL RIGHTS

I understand and acknowledge that by signing this document I am giving up all legal rights and all claims which I can legally make against the company, its agents, its employees, related entities, for their negligent acts or omissions arising out of my participation in the company’s activities or classes, or use of their equipment.

MY PARTICIPATION IS VOLUNTARY

My participation in activities or classes offered by the company, or use of the company’s rental equipment, is purely voluntary and no one is forcing me to participate. I elect to participate in spite of the risks.

MEDICAL TREATMENT

I hereby authorize any medical treatment deemed necessary in the event of any injury while participating in the activity or using their equipment.

MEDICAL AND RESCUE COSTS

I either have appropriate insurance, or, in its absence, agree to pay all costs of rescue and/or medical services as may be incurred on my behalf.

THE COMPANY HAS MADE NO OTHER PROMISES OR REPRESENTATIONS ABOUT THESE ACTIVITIES OR CLASSES, OR USE OF THE COMPANY’S RENTAL EQUIPMENT

I understand that the company has made no other promises or representations to me about the dangers, and risks of its activities or classes, or use of the company’s rental equipment, or our respective responsibilities for damages related to my participation in these activities or classes, or use of their equipment. This is the entire agreement between me and the company and may not be changed in any way by oral representations or statements of any agent or employee of the company.

SIGNATURE OF AGREEMENT AND ACKNOWLEDGEMENT

My signature below indicates that I have read this agreement, that I understand it, and that I voluntarily agree to be bound by its terms. I have had the opportunity to ask questions, and all questions have been answered to my complete satisfaction. I understand that this agreement is binding on me, my heirs, my assigns, and the personal representative of my estate.

YOU MUST READ AND UNDERSTAND THIS AGREEMENT BEFORE SIGNING IT !!

Today's Date: September 21, 2019

First Guest's Name

First Name*

Last Name*

Phone*
First Guest's Date of Birth*
First Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
First Guest's Signature*
Second Guest's Name

First Name*

Last Name*
Second Guest's Date of Birth*
Second Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
Third Guest's Name

First Name*

Last Name*
Third Guest's Date of Birth*
Third Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
Fourth Guest's Name

First Name*

Last Name*
Fourth Guest's Date of Birth*
Fourth Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
Fifth Guest's Name

First Name*

Last Name*
Fifth Guest's Date of Birth*
Fifth Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
Sixth Guest's Name

First Name*

Last Name*
Sixth Guest's Date of Birth*
Sixth Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
Seventh Guest's Name

First Name*

Last Name*
Seventh Guest's Date of Birth*
Seventh Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
Eighth Guest's Name

First Name*

Last Name*
Eighth Guest's Date of Birth*
Eighth Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
Ninth Guest's Name

First Name*

Last Name*
Ninth Guest's Date of Birth*
Ninth Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
Tenth Guest's Name

First Name*

Last Name*
Tenth Guest's Date of Birth*
Tenth Guest's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
Parent or Guardian's Email Address

Email
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*
Equipment Sizing

Height (feet & inches) *

Weight (lbs) *
Please estimate your Personal Floatation Device or "Life Jacket" size: (typically your sweatshirt size)*
Signature of Parent or Guardian is required if participant is under 18 years of age. By signing, Parent or Guardian acknowledges and agrees FOR HIMSELF OR HERSELF AND ON BEHALF OF THE MINOR PARTICIPANT to the contents of this document, including the acknowledgment and assumption of risks and agreements of release and indemnity. In addition, Parent or Guardian agrees to indemnify the company, its owners, agents and employees against claims of the minor participant and members of the minor participant’s family.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Medical Information

DO YOU OR HAVE YOU HAD...

Asthma*
No
Yes
Diabetes*
No
Yes
Heart Problems*
No
Yes
Seizures*
No
Yes
Allergies*
No
Yes

If you answered yes to any of the above, please elaborate:

Please list any recent injuries or surgeries :

Are you pregnant? If so, how far along... :

Any other health issues or mental / physical limitations your guide should be aware of :
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