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Inwood Canoe Club of NY, Inc.

AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY

 

READ BEFORE SIGNING.

NAME OF CLUB:  Inwood Canoe Club

COVERAGE TERM:  01/01/2019- 01/01/2020

GUEST PADDLER 

In consideration of being allowed to participate in any way in this sports activity, related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risk of injury from the activities involved in this sport 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, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such hazard to the attention of the nearest official immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS PADDLESPORT RISK MANAGEMENT, LLC; Inwood Canoe Club, NYC Parks The Arsenal Central Park, City of NY Parks & Recreation, Fort Tryon Park Cottage, their officers & directors, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, volunteers, coaches, steerers,  and, if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I also acknowledge that photographs and video may be taken of me in my participation in, and attendance at this event, and hereby freely agree to allow without restriction all uses of such photos and videos in the reporting of this race, and/or in the promotion of this event, its location, other sporting events, sport in general, and/or related purposes. 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.

First Guest Participant's Name

First Name*

Last Name*

Phone*
First Guest Participant's Date of Birth*
I certify that I am 18 years of age or older
First Guest Participant's Information
Are you able to swim?*
Yes
No
First Guest Participant's Signature*
Second Guest Participant's Name

First Name*

Last Name*
Second Guest Participant's Date of Birth*
Second Guest Participant's Information
Are you able to swim?*
Yes
No
Second Guest Participant's Signature*
Third Guest Participant's Name

First Name*

Last Name*
Third Guest Participant's Date of Birth*
Third Guest Participant's Information
Are you able to swim?*
Yes
No
Third Guest Participant's Signature*
Fourth Guest Participant's Name

First Name*

Last Name*
Fourth Guest Participant's Date of Birth*
Fourth Guest Participant's Information
Are you able to swim?*
Yes
No
Fourth Guest Participant's Signature*
Fifth Guest Participant's Name

First Name*

Last Name*
Fifth Guest Participant's Date of Birth*
Fifth Guest Participant's Information
Are you able to swim?*
Yes
No
Fifth Guest Participant's Signature*
Sixth Guest Participant's Name

First Name*

Last Name*
Sixth Guest Participant's Date of Birth*
Sixth Guest Participant's Information
Are you able to swim?*
Yes
No
Sixth Guest Participant's Signature*
Seventh Guest Participant's Name

First Name*

Last Name*
Seventh Guest Participant's Date of Birth*
Seventh Guest Participant's Information
Are you able to swim?*
Yes
No
Seventh Guest Participant's Signature*
Eighth Guest Participant's Name

First Name*

Last Name*
Eighth Guest Participant's Date of Birth*
Eighth Guest Participant's Information
Are you able to swim?*
Yes
No
Eighth Guest Participant's Signature*
Ninth Guest Participant's Name

First Name*

Last Name*
Ninth Guest Participant's Date of Birth*
Ninth Guest Participant's Information
Are you able to swim?*
Yes
No
Ninth Guest Participant's Signature*
Tenth Guest Participant's Name

First Name*

Last Name*
Tenth Guest Participant's Date of Birth*
Tenth Guest Participant's Information
Are you able to swim?*
Yes
No
Tenth Guest Participant's Signature*
Guest 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*
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*

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 Information
Are you able to swim?*
Yes
No
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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